全胃切除调节型双通道间置空肠消化道重建VIP专享VIP免费

【文章编号】1007-9424(2008)01-0023-04胃癌·临床研究全胃切除调节型双通道间置空肠消化道重建肖仕明3姜淮芜3陈进3肖平3郭海燕3孙燕3【摘要】目的介绍一种新的全胃切除消化道重建术。方法选取我院2004年6月至2006年3月期间行全胃切除病例38例。在行消化道重建时,对功能性空肠间置代胃(FJI)术作如下改良:将输出袢适度丝线结扎改为部分缩窄缝合2～3针,适当缩短输入袢肠管至20～25cm,Braun吻合口距Treitz韧带10cm,以食管空肠及Braun吻合口无张力为度。结果全组病例无围手术期死亡、吻合口漏及倾倒综合征发生。Roux2en2Y滞留综合征2例;返流性食管炎1例;Visick分级:35例Ⅰ级,3例Ⅱ级。血清营养学指标:仅2例血红蛋白低于正常。术后6个月,36例进食量和体重恢复术前水平,仅2例体重下降。造影钡剂主要进入十二指肠通道,少量通过部分缩窄通道。结论对FJI重建术的改良,不仅保留了原法的全部优点,而且可进一步降低并发症,改善患者生活质量,但需进行进一步的前瞻性对比研究。【关键词】功能性空肠间置代胃术改良全胃切除消化道重建【中图分类号】R656.61∶R735.2【文献标识码】ANewDoubleTractDigestiveReconstructionofTotalGastrectomy:TheModifiedFunctionalJejunalInterpositionXIAOShi2ming3,JIANGHuai2wu3,CHENJin3,XIAOPing3,GUOHai2yan3,SUNYan3.3TheSecondDepartmentofGeneralSurgery,TheSecondAffiliatedHospitalofNorthernSichuanMedicalCollege,Mianyang621000,ChinaCorrespondingAuthor:JIANGHuai2wu,E2mail:Jhuaiwu@yahoo.com.cn【Abstract】ObjectiveTodescribeanewtechniquefordigestivetractreconstructionoftotalgastrectomy.MethodsThemodifiedfunctionaljejunalinterposition(FJI)wasperformedin38patientswhounderwenttotalgas2trectomybetweenJune2004andMarch2006.Atdigestivetractreconstruction,thejejunumwithsuitablesutureli2gatedat2cmdistaltoside2to2endjejunoduodenostomywaschangedtosewup2-3needlesandtonarrowit.End2to2sideesophagojejunostomytoTreitzligamentwasshortenedto20-25cmbefittingly.Side2to2sidejejunojejunosto2mytoTreitzligamentwas10cm.Bothesophagojejunostomyandjejunojejunostomymustnotbetensioned.ResultsNopatientsdiedorhadanastomoticleakageinperioperativeperiod.Roux2en2Ystasissyndrome(RSS)wasin2patients.TheVisickgrade:35patientsweregradeⅠ,3patientsweregradeⅡ.Serumnutritionalparametersin2patientshemoglobinwasonlylowerthannormal.At6monthsafteroperation,foodintakepermealandbodyweightwererecoveredtothepreoperativelevelin36patients,andonly2patientsappearedweightworse.Onepatienthadrefluxesophagitisandnodumpingsyndromeoccurred.Throughtheuppergastrointestinalradiograph,thebariumsenteredintoduodenalchannelsmostly,andalittleintothenarrowchannels.ConclusionThemodifiedFJInotonlyreservedalladvantagesoftheprimaryprocedure,butalsocouldfurtherlowerthecomplicationsandimproveofthequantitylifeofthepatientswhowereunderwenttotalgastrectomy.Itwouldbenecessaryforfurtherprospectiverandomizedcontrolledtrialinthelargescalecases.【Keywords】FunctionaljejunalinterpositionModifiedTotalgastrectomyDigestivetractrecon2struction随着近端胃癌发病率的上升,全胃切除率逐渐增加[1～3]。术后并发的返流性食管炎、倾倒综合征、食欲减退、摄食不足、消化不良、体重下降、贫血等无【作者单位】3川北医学院附属第二医院普外二科(四川绵阳621000)【通讯作者】姜淮芜,E2mail:jhuaiwu@yahoo.com.cn【作者简介】肖仕明(1969年-),男,四川省绵阳市人,学士学位,主治医师,主要从事胃肠肿瘤的基础与临床工作,E2mail:xsmingd@sina.com。胃综合征,严重影响患者生活质量[4～8]。全胃切除术后患者的生活质量与消化道重建方式相关,但至今尚无标准的重建方式[4,5,9～11]。因此,积极探索改善患者术后生活质量的重建方法就成为胃肠外科学者追求的目标[9,10]。我们对郝希山等[4]设计的功能性空肠间置代...