胃大部切除幽门括约肌再造术临床研究和应用

Clinical Researches of Billroth Ⅰ Gastrectomy With Pyloric Reconstruction

目的:为了使因胃大部切除术后患者消化道重建更符合解剖,消化功能更接近生理,且提高生存质量。方法:依据胃十二指肠及幽门括约肌的解剖生理特征,利用残胃体自身的血供和神经支配,以大弯侧剥去粘膜后的奖肌层,再造"幽门括约肌枕"行 BILLROTH Ⅰ式,将十二指肠残端插入残胃体浆肌层内全层吻合,2 cm 浆肌层再履盖吻合,浆肌层的游离缘缝在十二指肠残端上的胃肠重建方式。结果:10例病人均一期愈合,恢复饮食,经 X 线钡餐复查,动态录相观察,重建幽门括约肌有控制胃排空的作用。结论:该术式与多家文献报告相比是更简单、安全、易行,不增加病人的痛苦,术后更接近正常解剖生理,手术适应证可为良恶性病变,患者生存质量提高。

Objective:In order to search for a new surgical method which accords with physiologico- anatomical principle and raises the life quality of patients undergoing gastrectomy.Method: The lesser curvature end of gastric remnant was sutured after partial gastric resection.A seromuscular valve of 2 cm wide was made in the greater curvature end.Billroth I anastomo- sis was performed and the seromuscular valve was sutured to surround the stoma.All pa- tients were followed up at regular intervals.Result:All of the 10 patients have resumed their normal life and work at present.Gastric emptying has been shown to be essential normal by barium meat examination.Conclusion:Our new method of pyloric reconstruction is safer,eas- ier,simpler and more effective than conventiona procedures in the literature