胃癌远端胃切除后消化道重建理论与实践

Theory and practice of digestive tract reconstruction of distal gastrectomy for gastric cancer

进展期胃下部癌占我国胃癌的主要部分,远端胃大部切除是主要的外科治疗方法之一。消化道重建方式是影响远端胃大部切除术后生存质量的重要因素。传统的重建方式为Billroth Ⅰ式或Billroth Ⅱ式。从保留十二指肠通路或抗胆汁反流角度,重建方式进行了多种改良,包括BillrothⅡ式+Braun吻合、Roux-en-Y吻合术、单管空肠间置、空肠贮袋间置、双通道重建。目前研究结果认为,Roux-en-Y吻合术是改善生存质量、可行性与可推广性均较理想的方式。

Advanced low third gastric cancer is the majority of gastric cancer in China. Distal gastrectomy is its principle procedure of surgical treatment. The digestive tract reconstruction pattern is the important factor for postoperative quality of life after distal gastrectomy. Conventional reconstruction patterns are Billroth I gastroduodenostomy and Billroth l] gastrojejunostomy. Regarding to preserve duodenal pathway or anti-bile reflux, there are several modified reconstruction patterns including Billroth II gastrojejunostomy plus Braun jejunojejunostomy, Roux-en-Y gastrojejunostomy, jejunal interposition, jejunal pouch interposition and double tract reconstruction. Based on current evidences, Roux-en-Y gastrojejunostomy is preferred as the better procedure to improve postoperative quality of life, as well as of better feasibility and promotion value.