胃癌切除后的胃十二指肠吻合术46例

Clinical Investigation of 46 Cases with Gastroduodenostomy after Gastric Re-section for Cancer

目的 探讨胃癌切除后胃十二指肠吻合的适应证和效果。方法 对46例胃癌切除后胃十二指肠吻合的病人进行回顾性研究。结果 5年存活率52％,6例(13％)死亡前存在肿瘤引起的吻合口梗阻,但与同期胃空肠吻合组无明显区别(P>0.05)。24例存活时间长于5年的病人中3例胃镜复查有胆汁返流引起的糜烂,但无1例发生边缘溃疡。结论 早期胃癌,特别是肿瘤距离胃幽门5cm以上者,远端胃切除后采用胃十二指肠吻合重建可获得较好的效果,肿瘤引起吻合口梗阻的发生率是可接受的。

Objective To evalute the effect and indication of gastroduodenostomy after gastric resection for cancer. Methods A retrospective study was undertaken in 46 cases with gastroduodenostomy after gastric resection for cancer. Results The 5-year survival rate was 52%. Of the 46 patients, 6(13% ) cases obstructed at the anastomostic site due to tumor recurrence before death, which was not significantly different from the cases with gastrojejunostomy ( P > 0. 05 ). Of the 24 patients who suvival time long then 5 years ,3 patients did experience symptomatic bile reflux gastritis documented with endoscopy and no incidences of marginal ulcers. Conclusion Gastroduodenostomy may be considered for patients undergoing resection for gastric cancer duo to its physiologic benefits and acceptable rate of obstruction,especially early cancer and rumor from pylorus >5 cm.