全胃切除消化道重建方式的探讨

Study of alimentary reconstruction after total gastrectomy

目的 探讨全胃切除后消化道重建方式的合理选择。方法 回顾性分析 86例全胃切除患者的临床资料。结果 86例患者中 ,胃癌 76例 ,恶性淋巴瘤 8例 ,平滑肌肉瘤 2例 ;Ⅱ期 17例 ,Ⅲ期 48例 ,Ⅳ期 2 1例。根治性全胃切除 48例 ,姑息性全胃切除 3 8例 ,其中联合脏器切除 2 8例 ,肝动脉置MT药泵 2 8例。消化道重建方式 :食道十二指肠吻合术 12例 ,食道空肠袢式吻合术 15例 ,食道空肠Roux en Y吻合术 2 9例 ,间置空肠加袋术 3 0例。术后并发症 18例 ,其中吻合口漏 3例 ,胰瘘 1例。术后症状 :烧心 2 1例 ,倾倒综合症 18例 ,餐后上腹饱胀 15例 ,腹泻 12例 ,吞咽困难 9例。结论 全胃切除后 。

Objective To investigate the ideal procedure of digestive tract reconstruction after tota l gastrectomy . MethodsThe clinical data of 86 cases underg oing total gastrectomy were reviewed retrospectively. ResultsTotal gastrectomy was performed in 86 cases, including 76 cases of ga stric carcinoma, 8 cases of malignant lymphoma and 2 of leiomyosarcoma;and 17 cases in stage II, 48 cases in stage III, and 21 cases in stage IV. Radical tot al gastrectomy was performed in 48 cases and palliative total gastrectomy in 38 cases. Gastrectomy combining with resection of tail of pancreas, splenec tomy, transverse colectomy or partial hepatectomy was performed in 28 cases; and with drug delivery system implanted into hepatic artery in 28 cases. The recon struction of digestive tract included esophagoduodenostomy in 12 cases, Braun es ophagojejunostomy in 15 cases, Roux-en-Y esophagojejunostomy in 29 cases, and jejunal pouch interposition in 30 cases. Postoperative complications occurred i n 18 cases, including anastomosis leakage in 3 cases and pancreatic fistula in 1 case. Postoperative heartburn occurred in 21 cases, dumping syndrome in 18 cases, epigastric fullness in 15 cases, diarrhoea in 12 cases, and dysphagia in 9 cases. Conclusions Jejunal pouch interposition is an i deal procedure for reducing the patients′ postoperative symptoms and improving the quality of life after total gastrectomy.