胃癌全胃切除术后新型消化道重建方式的临床研

Total gastrectomy for gastric cancer:a clinical study of a new technique of gastric reconstruction.

目的 探讨理想的全胃切除术后消化道重建方式。方法 对 1995～ 1999年经病理证实行全胃切除术胃癌 2 35例进行回顾性分析。其中 ,功能性间置空肠代胃术 (FJI) 78例 (33 .2 % ) ,“P”型Roux -en -Y空肠代胃术 (PR) 15 7例 (6 6 .8% )。随访 2年 ,比较其术后的并发症、Visick指数、体重变化。结果 89%的FJI术后病人的Visick指数为Ⅰ -Ⅱ ;PR的Roux -en -Y滞留综合征 (RSS)发生率为 42 .7%。倾倒综合征、返流性食管炎分别为 16 .7%、2 6 .5 %。结论 FJI保持了重建消化道神经 -肌肉功能的连续性 ,恢复食物经过十二指肠通道 ,对于减少全胃术的并发症、提高生存质量有重要意义 ,是全胃切除术后理想的消化道重建术式。

Objective To explore the ideal procedure of digestive tract reconstruction after total gastrectomy.Methods 235 patients with histologically proved gastric cancer underwent different types of reconstructive procedures for total gastrectomy and were analyzed retrospectively.The functional jejunal interposition was used in 78 cases, 'P' -Roux-en-Y modal of reconstruction was used in 157.In each subject,the postprandial symptoms and post-operation complications,Visick scoring,weight loss were evaluated.Results The Visick scoring of the 89.9% patients with functional jejunal interposition was Ⅰ-Ⅱgrades.RSS of Roux-en-Y reconstruction was 42.7%,reflux oesophagitis and dumping were 26.5%,16.7% respectively.Conclusion The functional jejunal interposition is an sensible reconstruction after total gastrectomy in terms of the quality of life of the patients and for maintaining the continuity of neuro-muscle function of the reconstructive gastric tract and the canal of the chyme through the duodenal tract.