间置空肠代胃在胃癌全胃切除术后的临床应用

Clinical Application of Jejunal Interposition ReconstructionAfter Total Gastrectomy in Patients With Gastric Carcinoma

目的 分析胃癌行全胃切除后Ⅰ或Ⅱ型间置空肠代胃生理功能。方法 31例胃癌行全胃切除术 ,其中胃底贲门癌经胸腹联合切除 8例 ,行Ⅰ型间置空肠代胃吻合 3例 ,Ⅱ型间置空肠代胃 5例 ;胃体癌经腹切除者 2 3例 ,其中Ⅰ型吻合 13例 ,Ⅱ型 10例。结果 两组均无手术死亡率及吻合口瘘发生。术后 1个月至 6个月作钡餐检查 ,见间置空肠袢均呈不同程度的“囊袋”扩张。 30～ 6 0minⅠ型和Ⅱ型排空时间分别为 6 2 5 %和 6 6 7% ,80～ 12 0min内分别为 37 5 %和 33 3%。饮食恢复正常 ,血浆总蛋白 5 6～ 75g/L ,占 74 2 % (2 3/ 31) ,4 6～ 5 5g/L2 5 8% (8/ 31)。血红蛋白 110～ 16 0g/L占 38 7% (12 / 31) ,96～ 10 5g/L 6 1 3% (19/ 31)。体重比发病前减轻 3～5kg ,从事较轻的体力劳动者 9例。按Visik分级 ,全组患者生活质量达到Ⅱ～Ⅲ级之间。结论 临床II、Ⅲ期的胃上部癌应选择行全胃切除术 ,而全胃切除术后间置空肠Ⅰ型或Ⅱ型代胃能提高病人生活质量。

Objective To evaluate the therapeutic effect of the jejunal interposition reconstruction type Ⅰ and Ⅱ after total gastrectomy in patients with gastric carcinoma.Methods 31 cases of gastric carcinoma operated were retrospectively analyzed, 16 patients after total gastrectomy were reconstructed to have a jejunal interposition type Ⅰ and 15 a jejunal interposition reconstruction type Ⅱ. The clinic data of the two types jejunal interposition reconstruction were assessed during 6 months ～5 years follow-up. Results 30- 60 minutes and 80-120 minutes barium agent emptying time of type I and II were 62.5%,66.7% and 37.5%,33.3% respectively;normal diet regimen(4～6 meals/d)was recovered,plasma total protein 56～75g/L accounted for 74 2%(23/31),46～56g/L accounted for 25 8%(8/31).Hemoglobin 110～160g/L accounted for 38 7%(12/31) 96～105g/L accounted for 61 3%(19/31).Mean body weight was decreased by 3～5kg in all groups.9 cases recovered eight physical strength labor.The visick scoring of the 87 7% patients with type I and the 86 7% patients with type II was I-II grades. Reflux oesophagitis of the patients with type I was 12 5%. Conclusions The jejunal interposition reconstruction type Ⅰ and Ⅱ is suitable reconstruction after total gastrectomy to improve quality of life and to reduce complications and to maintain the canal of the chyme through the duodenal tract.