胃空肠袢吻合术疗效探讨

Therapeutic investigation of ansiform gastrojejunostomy

目的探讨胃空肠袢吻合术的近远期疗效。方法统计１９８３～２０００年传统Ⅱ式、Ｒｏｕｘ－ｅｎ－Ｙ式、胃空肠袢吻合术３种术式治疗十二指肠球部溃疡共４５１例的早期并发症，并随访１０年以上病例３组共１３６例，按Ｖｉｓｉｃｋ分级对比、９９ｍＴｃ标记的ＥＨＩＤＡ测胆汁肠胃反流指数进行评估。结果早期并发症发生率：胃空肠袢吻合术０（０／１０１），传统Ⅱ式２．３％（７／３０５），Ｒｏｕｘ－ｅｎ－Ｙ式２．２％（１／４５）。１０年以上随访：Ｖｉｓｉｃｋ分级，Ⅲ加Ⅳ级：胃空肠袢吻合术（３／６０例）明显少于传统Ⅱ式（１１／４１例，其中残胃痛１例）（Ｐ＜０．０５）和Ｒｏｕｘ－ｅｎ－Ｙ式（３／３５例，其中吻合口溃疡穿孔１例）。反流指数Ⅲ℃以上：胃空肠袢吻合术（１２／６０例）明显少于传统Ⅱ式（３５／４１例）（Ｐ＜０．０５）。结论胃空肠袢吻合术可有效地减少胃切除术后早期并发症和胆汁肠胃反流，近远期疗效均优于传统Ⅱ式和Ｒｏｕｘ－ｅｎ－Ｙ式。

Objective To investigate the short-and long-term therapeutic effect of ansiform gastrojejunostomy. Mehtods The data of early complications in 451 cases with duodenal ulcer which underwent Billroth Ⅱ, Roux-en-Y and ansiform gastrojejunostomy from 1983 to 2000 were analyzed. Among above cases, 136 patients, with more than 10 years follow-up, were reviewed by Visick's grading, the regurgitation index of bile by EHIDA marked with 99mTc. Results Early complications showed 0/101 in ansiform gastrojejunostomy, 7/305 in Billwth Ⅱ, 1/45 in Roux-en-Y. Visick's Ⅲ + IV presented 3/60 in ansiform gastrojejunostomy, which was significantly less than that in Billroth Ⅱ(11/41 )and Roux-en-Y(3/35) Beyond regurgitation index ⅢⅢ, ansiform gastrojejunostomy was 12/60 and significantly less than Billroth II (35/41). ConclusIons Ansiform gastrojejunostomy can reduce early postoperative complications and bile regurgitation. Its short- and long-term therapeutic effects are better as compared to Billroth Ⅱ and Roux-en-Y operations.