胃大部分切除术后输入袢综合征的预防及外科处理

Prevention and Surgical Treatment of Afferent Loop Syndrome Following Subtotal Gastrectomy

目的 探讨胃大部分切除术后输入袢综合征的病因、预防、临床表现、诊断和治疗。方法 对 10例输入袢综合征的手术史、临床表现、影像学检查及治疗进行总结分析。结果 10例均再次剖腹手术 ,术中见输入袢不同程度的扩张 ,6例行Roux -en -Y吻合术 ,4例行Braun吻合术 ,无围手术期死亡 ,追踪观察 2～ 5年 ,均无复发。结论 输入袢综合征的发生与不正确的手术操作技术有很大关系 ,改进手术技术对预防输入袢综合征非常重要。诊断明确后 ,应尽早再手术 ,可选择行Billroth -Ⅰ式手术、Roux -en -Y吻合术。

Objective To investigate the cause, the prevention, the clinical manifestation,the diagnosis and the treatment of afferent loop syndrome following Billroth-Ⅱ-subtotal gastrectomy.Methods 10 cases of afferent loop syndrome whose history of operation, clinical manifestation, imaging examinations, and treatment were analyzed.Results Laparotomy was done again for all the 10 patients. Different extent of dilated afferent loop were seen intraoperatively. 6 patients underwent the Roux-en-Y anastomosis and the other 4 patients underwent the Braun anastomosis. No patients were died perioperatively. No recurrence was observed in followed up for 2 to 5 years after the operation.Conclusions Occurrence of afferent loop syndrome is associated with the incorrect operation technique. Improving the operation technique should be emphasized for preventing afferent loop syndrome. Once the definite diagnosis of afferent loop syndrome was worked out, the laparotomy shoud be done again as soon as possible. The optional operation can choose the Billroth-Ⅰoperation, the Roux-en-Y anastomosis, the Braun anastomosis or jejunal interposition,respectively.