全胃切除术后Roux-en-Y和储袋吻合的近期疗效

Roux-en-Y anastomosis combined with pouch digestive tract reconstruction after total gastrectomy

目的探讨全胃切除术中采用Roux-en-Y＋储袋吻合进行消化道重建的近期疗效。方法回顾性分析2013年7月至2013年11月四川大学华西医院收治的7例食管胃结合部腺癌、3例胃体癌患者的临床资料。患者采用全胃切除＋D：淋巴结清扫术，消化道重建采用横结肠前Roux-ell-Y十储袋吻合。采用门诊或电话进行随访，了解患者术后恢复情况，随访时间截至2013年11月。分析患者手术时间、术中出血量、术后住院时间、术后并发症发生率及病死率等手术疗效指标。结果10例患者中，5例采用经腹路径，5例采用经食管裂孔路径。手术时间为（266±23）rain，出血量为（143±40）mL，术后住院时间为（9．3±0．5）d。1例患者术后发生腹腔感染、弥漫性腹膜炎（非吻合口漏导致），经腹腔冲洗引流治疗后痊愈。无吻合口漏、吻合口出血、腹腔出血等手术并发症发生，无手术死亡。所有患者达到Rn切除，淋巴结清扫数目为（45±18）枚（26～90枚），阳性淋巴结数目为0～72枚。10例患者获得随访，短期内无明显烧心症状，进食量及进餐数均自觉满意。结论全胃切除术后采用Roux-elq-Y＋储袋吻合进行消化道重建安全可行，近期疗效满意。

Objective To investigate the short-term safety and efficacy of Roux-en-Y anastomosis com- bined with pouch digestive tract reconstruction after total gastrectomy. Methods The clinical data of 7 patients with adenocarcinoma of the esophagogastric junction and 3 patients with gastric cancer who were admitted to the West China Hospital from July 2013 to November 2013 were retrospectively analyzed. All the patients received Roux-en-Y anastomosis and pouch digestive tract reconstruction following total gastrectomy ＋ D2 lymphadenectomy. The follow-up was performed through out-patient examination or phone call till November 2013. The operation time, intraoperative blood loss, duration of postoperative hospital stay, incidence of postoperative complications and mortality were analyzed. Results Transabdominal approach was adopted in 5 patients and transhiatal approach was adopted in the other 5 patients. The operation time, volume of blood loss and duration of postopera- tive hospital stay were （ 266 ＋ 23 ） minutes, （ 143 _＋ 40 ） mL and （ 9.3 -＋ 0.5 ） days. One patient was complicated with abdominal infection and diffuse peritonitis （non anastomotic leakage related）, and cured by abdonfinal drainage. No anastomotic leakage, bleeding, peritoneal bleeding occurred, and no patient died during the operation. All patients received R0 resection, and the number of lymph nodes dissected was 45 -＋ 18 （range, 26-90） , and the number of lymph node with positive expression was 0-72. Ten patients were followed up. They were satisfied to the food intake and the heartburn symptom was controlled. Conclusion Roux-en-Y anastomosis combined with pouch digestive tract reconstruction after total gastrectomy is safe, feasible, and the short-term efficacy is satisfactory.