胃癌切除胃肠短袢Roux-en-Y瓣式吻合术183例临床观察

Clinical investigation of 183 cases with short Roux limb Roux-en-Y valve-shaped gastrojejunostomy after gastrectomy for gastric carcinoma

目的评价胃肠短拌Ｒｏｕｘ－ｅｎ－Ｙ瓣式吻合术的抗反流效果，探讨Ｒｏｕｘ淤积综合征的防治方法。方法 随访１９８６年１０月至１９９７年６月胃癌切除胃空肠短拌Ｒｏｕｘ－ｅｎ－Ｙ瓣式吻合术１８３例，通过症状调查，按改良Ｖｉｓｉｃｋ标准评级，有症状者借助消化道钡餐、胃镜并活检、Ｂ超、ＣＴ检查排除吻合口狭窄、残胃溃疡和肿瘤复发后，确定短袢Ｒｏｕｘ－ｅｎ－Ｙ瓣式吻合术的抗反流效果及Ｒｏｕｘ淤积综合征的发病率。结果 １７２例（９４．０％）获随访结果，５例不满２年因肿瘤复发死亡，３例术后胃瘫，２例因粘连性肠梗阻接受粘连松解术，２例因腹膜广泛种植转移癌致肠梗阻。可进行改良Ｖｉｓｉｃｋ评级者１６５例，Ⅲ、Ⅳ级者１２例皆为肿瘤复发，未发现有明显症状的反流性胃炎，无倾倒综合征和Ｒｏｕｘ淤积综合征。结论 扩大胃的切除范围，同时缩短Ｒｏｕｘ袢的长度，可防治Ｒｏｕｘ淤积综合征，对空肠空肠吻合口进行抗反流加工，短袢Ｒｏｕｘ－ｅｎ－Ｙ吻合抗反流效果满意。

Objective To evaluate the antireflux effect of Roux-en-Y procedure with a short Roux limb and a modified jejunojejunostomy (short Roux limb Roux-en-Y valve-shaped gastrojejunostomy) and to investigate the method of preventing and treating Roux stasis syndrome. Methods 183 patients treated with the Roux-en-Y reconstruction with a short limb and a modified jejunojejunostomy after gastrectomy for cancer of the stomach were followed up from October 1986 to June 1997. The modified Visick scale was used for clinical ratings. For the patients with Visick II, Visick III or Visick IV , upper gastrointestinal series, endoscopy with biopsy, ultrasonography and computed tomography were used to exclude gastric remnant ulcer, anastomotic stenosis and recurrence of the tumor. All the patients without recurrence of tumor, if only the follow-up data were obtained, were evaluated, namely, the frequency of the reflux gastritis and the rate of Roux stasis syndrome were determined. Results The follow-up data were obtained from 172 of 183 patients. Total 19 patients with recurring tumors were not evaluated, and of 153 remaining patients, none had development of dumping syndrome, Roux stasis syndrome and evident alkaline reflux gastritis. Conclusions Increasing excised size of the stomach and simultaneously shortening the length of Roux limb can prevent and treat the Roux stasis syndrome. The modified jejunojejunostomy Roux-en-y anastomosis with a short limb also has an excellent antireflux result.