带血管蒂空肠在重建消化道中的应用

Application of jejunum with vascular pedicle in reconstruction of the digestive tract

目的 应用带血管蒂空肠替代食管、胃重建消化道，观察空肠代食管、胃的手术效果及患者的术后生活质量。方法 全组25例患者，其中行近端胃次全切除“P”型襻空肠间置10例；全胃切除主动脉弓下“P”型襻空肠-食管吻合术13例；全胃切除主动脉弓上空肠-食管吻合术2例。术后3个月进行食管内pH值监测，钡餐、胃镜检查，并观察患者的生活质量。结果 全组术后无吻合口漏及胸腹腔感染发生；患者术后均进食通畅，无明显返流性食管炎症状及病理征象；食管pH值均在5．5-6.6。术后存活5年以上8例。结论 带血管蒂空肠代食管、胃重建消化道术式，尤其是对食管中下段癌、贲门癌的效果确切，并发症低，术后生活质量良好，值得推广应用。

Objective To reconstruct the digestive tract using the jejunum with vascular pedicle after esophagectomy or gastrectomy, and observe the therapeutic effects and the patients' quality of life after the operation. Methods This study included a total of 25 patients, 10 of whom received proximal subtotal gastrectomy followed by reconstruction of the digestive tract with P-shaped jejunum for anastomosis of the esophagus and the residual stomach, 15 had total gastrectomy and anastomosis of the P-shaped jejunum with the esophagus inferior to the arch of aorta, with another 2 having total gastrectomy and the anastomosis superior to the arch of aorta. The pH value of the esophagus was tested, barium meal and gastroscopy were carried out 3 months after the operations, and the patients' quality of life assessed. Results Anastomotic leakage or infections in the thoracic or abdominal cavity occurred in none of the patients. All the patients had no postoperative difficulty in eating cooked rice, and were free of reflux esophagitis and burning sensation in the chest. The pH value of the esophagus was 5.5-6.6. Eight patients survived for more than 5 years. Conclusions The effects of digestive tract reconstruction using the jejunum with vascular pedicle after esophagectomy or gastrectomy are satisfactory, especially in patients with esophageal cancer in the lower section or cardia cancer. This operation gives rise to low rate of operative complications, and insures good quality of life of the patients.