连续顺蠕动空肠间置在近端胃切除消化道重建中的应用

Application of Continuous Iso-peristaltic Anastomosis with Jejunal Interposition in Digestive Tract Reconstruction After Proximal Gastrectomy

[目的]探讨连续顺蠕动空肠间置在近端胃切除术后消化道重建中的价值。[方法]对22例患者进行近端胃切除、连续顺蠕动空肠间置吻合消化道重建,术后随访至6个月。[结果 ]所有患者均顺利完成连续顺蠕动空肠间置重建,术后病理切缘阴性,术后近期未出现出血、吻合口瘘等吻合直接相关并发症,但存在1例吻合口狭窄伴胸腹腔积液,1例胃瘫,经对症处理后好转。远期随访仅1例患者因结扎线脱落导致较严重的反流性食管炎,1例患者因肿瘤进展出现肠梗阻,其余患者均饮食良好,体重恢复,胃肠造影、胃镜等基本正常。[结论]连续顺蠕动间置空肠吻合简便、牢靠,近期、远期并发症少,有利于生活质量恢复,具有在临床推广的价值。

[Purpose] To investigate the value of COrltinuous iso-peristaltic anastomosis with jeju- nal interposition in digestive tract reconstruction after proximal gastrectomy. [ Methods ] Twenty- two cases undergoing continuous iso-peristaltic anastomosis with jejunal interposition in digestive tract reconstruction after proximal gastrectomy were followed up for 6 months after surgery. [Re- sults] All patients successfully completed continuous iso-peristaltic digestive tract reconstruction with jejunal interposition,with pathological negative margins,without early postoperative compli- cations related to anastomosis,such as bleeding or anastomotic leakage. But 1 case presented anastomotic stenosis and abdominal effusion; 1 case,gastroplegia;both of them recovered after symptomatic treatment. In long-term follow-up, 1 case presented severe reflux esophagitis due to loose ligature; 1 case,intestinal obstruction due to tumor progression,while the remaining pa- tients were having well diet and appetite ,regaining weight recovered, and normal in gastrointesti- nal imaging and endoscopy examination. [Conclusion] Continuous iso-peristahic anastomosis with jejunal interposition in digestive tract reconstruction is simple ,reliable ,with less early or late comp1ications. It does make for recovery of quality of life, with the value of clinical promotion.