全胃切除代胃空肠行抗返流术式预防食道返流的研究

Prevention of Esophageal Regurgitation by Total Gastrectomy for Gastric Emptying and Anti Reflux Procedure

目的探讨近端胃癌行根治性全胃切除,空肠-空肠储袋胃、储袋胃的近、远端空肠行抗返流瓣术式、空场-空肠Rouxen-Y吻合术预食道返流的可行性。方法将2003年1月~2012年12月我院收治的行近端胃癌根治手术的患者87例随机分为两组,对照组43例行全胃切除空肠储袋胃、空肠-空肠Roux-en-Y吻合的胃癌根治术,实验组44例行空肠储袋胃、储袋胃的近、远端空肠行抗返流瓣术式、空场-空肠Roux-en-Y吻合术预防食道返流,观察两组患者术后是否有吻合口狭窄、术后进食时间、肠道恢复时间、术后住院时间、钡剂停留时间。术后2个月随访营养状况,随访至6个月,根据Mettin标准评估两组患者食管黏膜组织学炎症改变、是否有反流性食管炎以及患者生存率。结果术后两组患者恢复良好,均无吻合口狭窄。两组患者进食时间、肠道恢复时间、术后住院时间组间对比,差异无统计学意义(P>0.05)。实验组钡剂停留时间长于对照组,差异具有统计学意义(P<0.05)。术后2个月随访两组病例食欲良好,血红蛋白上升、体重无减轻,营养状况良好。对照组出现食管炎症改变的例数多于实验组,两组相比,统计学意义显著(P<0.01);对照组出现返流性食管炎例数多于实验组,差异具有统计学意义(P<0.05)。所有患者均随访1年,1年内无患者死亡。结论若严格的把握适应证,近端胃癌行根治性胃全切除行空肠-空肠储袋胃、储袋胃的近、远端空肠行抗返流瓣术式、空场-空肠Roux-en-Y吻合术能有效预防食道返流,可降低返流性食管炎的发生率,显著改善患者的生存质量。

Objective To investigate the feasibility of radical total gastrectomy, jejunojejunal bag storage,proximal and distal jejunum with anti-reflux valve and jejunostomy with Roux-en-Y jejunostomy.Methods From January 2003 to December 2012,87 patients with proximal gastric cancer were randomly divided into two groups.The control group（43 cases）underwent radical gastrectomy with total gastrectomy and Roux-en-Y jejunostomy.In the experimental group,44 cases were treated with jejunal bag-storing stomach,proximal and distal jejunum with anti-regurgitation valve.Roux-en-Y jejunostomy was performed to prevent esophageal reflux.Postoperative anastomotic stenosis,postoperative feeding time,intestinal recovery time,postoperative hospital stay and barium retention time were observed in the two groups.Nutritional status was followed up to 6 months after 2 months.The histologic changes in the esophageal mucosa,reflux esophagitis and the survival rate of the esophageal mucosa were evaluated according to the Mettin criteria in the two groups.Results After operation,the two groups recovered well without anastomotic stenosis.There was no significant difference between the two groups in eating time,intestinal recovery time and postoperative hospitalization time（ P〉0.05）.The retention time of barium in the experimental group was longer than that in the control group,the difference was statistically significant（ P〈0.05）.After 2 months of follow-up,two groups of patients had good appetite,increased hemoglobin,no weight loss,and good nutritional status.The number of cases of esophageal inflammation change in the control group was more than that in the experimental group.The statistical significance of the two groups was significant（P〈0.01）,and the number of reflux esophagitis in the control group was more than that in the experimental group,the difference was statistically significant（P0.05）.All patients were followed up for 1 years,and no patient died within 1 years.Conclusion If the indications are strictly grasped, the proximal gastric carcinoma with radical ggastrostomy,the close to the jejunum bag stomach,the close to the bag stomach, the distal jejunum anti reflux valve and the empty jejunum Roux-en-Y anastomosis can effectively prevent the reflux of the esophagus,which can reduce the incidence of reflux esophagitis and improve the quality of life of the patients.