腹腔镜远端胃切除术后消化道重建术式选择与策略

Selection and strategy of digestive tract reconstruction after laparoscopic distal gastrectomy

腹腔镜远端胃切除术是胃下部癌的主要手术方式,消化道重建作为手术重要的组成部分直接影响患者术后生活质量。BillrothⅠ式吻合、BillrothⅡ式吻合.Roux-en-Y吻合及其相对应的改良术式Braun吻合及UncutRoux-en-Y吻合是现阶段的主流重建术式。BillrothⅠ式吻合符合生理结构,但受限于原发肿瘤的大小及位置。BillrothⅡ式吻合则对肿瘤分期无要求,解决了吻合口张力问题,在联合Braun吻合后,术后反流性胃炎风险明显降低。Roux-en-Y吻合则彻底解决了碱性反流性胃炎,但其操作复杂,破坏了肠道的连续性,术后易导致Roux-en-Y潴留综合征。虽然Uncut Roux-en-Y吻合有几率发生输入袢再通,但仍是目前较为理想的重建术式。

Laparoscopic distal gastrectomy is the main surgical method for lower gastrie cancer.As an.important part of surgery,digestive tract reconstruction directly affects the postoperative quality of life of patients.BillrothⅠanastomosis,BillrothⅡanastomosis,Roux-en-Y anastomosis and their corresponding improved methods,Braun anastomosis and Uncut Roux-en-Y anastomosis,are the main reconstruction methods at present.The BillrothⅠanastomosis was physiologically consistent,but was limited by the size and location of the primary tumor.BillrothⅡanastomosis had no tumor staging requirements and solved the problem of anastomotic tension.After combined Braun anastomosis,the risk of postoperative reflux gastritis was significantly reduced.Roux-en-Y anastomosis completely solved bile reflux gastritis,but the operation was complicated and the intestinal continuity was damaged,which was prone to Roux-en-Y stasis syndrome after surgery.Although Uncut Roux-en-Y anastomosis may cause recanalization of the afferent limb,it is still a relatively ideal reconstruction method.