胃切除术后非离断式Roux-en-Y消化道重建的临床研究

Study on a new type of uncut Roux-en-Y reconstruction after subtotal gastrectomy

目的探讨胃大部切除术后非离断式Roux-en-Y消化道重建方式的临床效果。方法对1994年5月至2002年4月的152例胃大部切除术后的患者施行非离断式Roux-en-Y吻合术(A组)53例,Roux-en-Y吻合术(B组)37例,BillrothⅡ吻合术(C组)62例。非离断式Roux-en-Y吻合术是在传统的BillrothⅡ术式基础上,在空肠输入袢与输出袢之间加作空肠-空肠Braun吻合,同时对靠近胃肠吻合口的输入袢用10号丝线束扎阻断。将3种吻合术后近期和远期并发症发生情况进行对照研究。结果全组术后随访均在6个月以上,术后近期内并发症发生率A、B、C组分别为9.4%、13.5%和16.1%,3组比较差异无显著性意义;碱性反流性胃炎的发生率分别为1.9%、5.4%和33.9%,A、B组均明显低于C组(P<0.01);Roux潴留综合征A组无1例发生,B组发生率为24.3%,两组差异有显著性意义(P<0.01)。3组总的术后并发症发生率分别为11.3%、43.2%和50.0%,A组显著低于B、C组(P<0.01)。同时发现,术后体重下降者在C组较A组更为常见(P<0.01)。结论非离断式Roux术在保留传统Roux术式抗反流优点的同时,克服了传统术式易发生Roux潴留综合征的弊病,是胃大部切除术后理想的消化道重建术式。

Objective To evaluate the results of different types of reconstruction after subtotal gastrectomy. Methods From May 1994 to April 2002, 53 patients underwent a new type of uncut Roux en Y reconstruction (group A), 37 patients conventional Roux en Y gastrojejunostomy (group B), and 62 patients Billroth Ⅱ anastomosis(group C).The new type of uncut Roux en Y gastrojejunostomy,a modified Billroth Ⅱ gastrojejunostomy, was performed with the afferent jejunal lumen ligated with a silk thread, and pancreaticobiliary secretions diverted through a jejunojejunostomy(Braun anastomosis). The early and late complications were analyzed. Results The early morbidity rates were 9.4%, 13.5%, and 16.1% respectively in group A, B and C, and there were no significant differences among them. The incidence of alkaline reflux gastritis was 1.9% in group A and 5.4% in group B, both significantly lower than 33.9% in group C (P< 0.01). Roux stasis syndrome occurred in 9 patients (24.3%) in group B and 0 in group A(P< 0.01 ). The overall morbidity rate was 11.3% in group A, significantly lower than 43.2% and 50%in group B and group C(P< 0.01). Weight loss was more common in group C than that in group A(P< 0.01). Conclusions The new uncut Roux operation can prevent alkaline reflux gastritis and Roux stasis syndrome. It may be a standard procedure for reconstruction after subtotal gestrectomy.