近端胃切除、胃空肠Roux-en-Y吻合术的应用

Application of Roux-en-Y Gastrojejunostomy after Proximal Ga strectomy

目的 研究近端胃大部分切除术后行食管胃吻合、胃空肠Roux en Y吻合术对控制返流性食管炎的作用。方法 选择胃底贲门癌患者 2 6例 ,随机分为实验组 ( 14例 )和对照组 ( 12例 ) ,实验组行近端胃切除术后 ,行食管残胃吻合和保留幽门的胃空肠Roux en Y吻合术 ,对照组行近端胃切除术后 ,行食管残胃吻合术和幽门成形术。术后半年通过胃镜观察两组病例的食管胃吻合口的炎症反应 ,并行放射性核素标记胃排空检查 ,比较两组手术的效果及术后生存情况。结果 实验组术后胃肠道症状较对照组轻。放射性核素标记胃排空检查显示 ,实验组半量排空时间、10min后胃放射性核素残留率及 60min后胃内残留率与健康人相似 ,而对照组则延长或增高。胃镜病理检查结果显示 ,实验组食管胃吻合口的炎症反应比对照组轻 ,两组术后 5年生存率无差异。结论 胃底贲门癌行近端胃大部分切除术后行食管残胃吻合术 +保留幽门的胃空肠Roux en Y吻合术与行食管残胃吻合术 +幽门成形术相比 ,前者有降低返流性食管炎。

Objective To prospectively study the effect of preventing postoperative reflux esophagitis with esophagogastrostomy a nd Roux-en-Y gastrojejunostomy after proximal subtotal gastrectomy.Methods Twenty-six cases of carcinoma of the gastric fundus and cardia were allocated randomly to 2 groups (the control group with 12 cases and the experimental group with 14 cases) according to odd or eve n number of the admission number.After proximal subtotal gastrectomy and esophag ogastrostomy, the control group underwent pyloroplasty while the experimental gr oup with pylorus-preserving Roux-en-Y gastrojejunostomy.The inflammatory reac tion of the tissue obtained at the esophagogastric junction using a fiber gastro scope was observed after half year of postoperative follow-up in the two groups .An examination of gastric emptying of a radionuclide-labeled test meal were pe rformed.According to the Visick score of follow-up data,the effects of operatio n were evaluated.The 5-year survival rate was also evaluated.Results The postoperative gastrointestinal symp toms in the experimental group were slighter than those in the control group.The examination of gastric emptying of a radionuclide-labeled test meal showed tha t the gastric emptying time of a half dose,gastric remains rates of radionuclide after 10 min and 60 min in the experimental group were similar to those in the control healthy people group.But in the control group,the gastric emptying time of a half dose delayed,and the gastric remains rate of radionuclide after 10 min and 60 min were higher than the other groups.The biopsy study of the esophagoga stric junction showed that the inflammatory reaction in the experimental group w as slighter than that in the control group.There was no significant difference b etween the two groups in the survival rate.Conclusion For patients with carcinoma of the g astric fundus and cardia, after proximal subtotal gastrectomy and esophagogastro stomy,compared with pyloroplasty,pylorus-preserving Roux-en-Y gastrojejunosto my can decrease the reflux esophagitis,and relieve the postoperative gastrointes tinal symptoms.