全胃切除后“不切断”Roux-en-Y食管空肠吻合法(附16例报告)

Uncut" Roux-en-Y Esophagojejunostomy after Total Gastrectomy (A Report of 16 Cases)

目的 防治Roux en Y滞留综合征的发生。 方法 对 16例全胃切除的患者施行“不切断”Roux en Y食管空肠吻合手术 :提起空肠与食管行侧端吻合 ,行空肠肠间Braun吻合以转流十二指肠液 ,以缝合器缝闭或以丝线结扎阻断空肠襻上升支 ,并行间断浆肌层缝合加固。另以同期行全胃切除Roux en Y食管空肠吻合术 16例为对照组。 结果术后出现Roux滞留综合征者 ,全胃切除“不切断”Roux en Y食管空肠吻合组仅 2例 ( 12 .5 % ) ,而对照组 6例 ( 37.5 % )。施行全胃切除“不切断”Roux en Y食管空肠吻合手术的患者术后VisickⅠ级 6例 ( 37.5 % ) ,VisickⅡ级 7例 ( 43.75 % ) ,VisickⅢ级 3例 ( 18.75 % ) ,而对照组术后VisickⅠ级 3例 ( 18.75 % ) ,VisickⅡ级 6例 ( 37.5 % ) ,VisickⅢ级 6例 ( 37.5 % ) ,VisickⅣ级 1例 ( 6.2 5 % )。 结论 “不切断”Roux en

Objective To investigate the operative approach for prevention of Roux-en-Y stasis syndrome. Methods 'Uncut' Roux-en-Y esophagojejunostomy were performed in 16 patients undergoing total gastrectomy. Another 16 patients underwent routine Roux-en-Y esophagojejunostomy following total gastrectomy were compared as the control. The detail performance of 'Uncut' Roux-en-Y was side-end esophagojejunostomy with a Braun anastomosis made between the ascending and descending jejunum limbs and an anastomat closure or suture ligation was made on the ascending jejunum limb proximal to the Braun's anastomasis. Results The Roux-en-Y stasis syndrome only taken place in 2 patients (12.5%) with uncut reconstruction, while it was 6(37.5%) in Roux-en-Y reconstructed ones. In the patients of 'Uncut' esophagojejunostomy group, there were 6 (37.5%)cases of Visick Ⅰ,7(43.75%)cases of Visick Ⅱ,3 (18.8%) cases of Visick Ⅲ. In the control group,there were 3(18.75%) cases of Visick Ⅰ, 6(37.5%) cases of Visick Ⅱ, 6 (37.5%) cases of Visick Ⅲ and 1(6.25%) cases of Visick Ⅳ. Conclusion 'Uncut' Roux-en-Y esophagojejunostomy may have some effect on preventing the Roux-en-Y stasis syndrome.