全胃切除消化道重建方式的探讨  

Study of alimentary reconstructions after total gastrectomy for cancer

作　　者：程应东[1] 单志堂[1] 周培建[2] 张永川[2] 

机构地区：[1]第三军医大学附属新桥医院普通外科,重庆400037 [2]四川省达州市中心医院外科

出　　处：《临床外科杂志》2003年第S1期7-8,共2页Journal of Clinical Surgery

摘　　要：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。 86例中 ,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 ,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 :食管十二指肠吻合术 12例 ,食管空肠袢式吻合术 15例 ,食管空肠Roux Y吻合术 2 9例 ,间置空肠加袋术 3 0例。结果　术后并发症 18例 ,其中吻合口漏 3例 ,胰漏 1例。术后症状 :烧心 2 1例 ,倾倒综合征 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 ,间置空肠加袋术在改善病人术后症状和生活质量方面是比较理想的重建术式。Objective To investigate the ideal procedure of digestive tract reconstruction after total gastrectomy.Methods The clinical data of total gastrectomy in 86 patients with cancer was analyzed retrospectively.Total gastrectomy was performed in 86 patients, among them,gastric carcinoma in 76 cases,malignant lymphoma in 8 cases,leiomyosarcoma in 2 cases.And stageⅡ in 17 cases,stageⅢ in 48 cases,stageⅣ in 21 cases.Radical total gastrectomy was performed in 48 cases,palliative total gastrectomy in 38 cases,combined with resection of tail of pancreas,splenectomy,transverse colectomy or parietal hepatectomy in 28 cases.Medicine pump was placed into hepatic artery in 28 cases.Reconstruction of digestive tract:esophagoduodenostomy in 12 cases,braun esophagojejunostomy in 15 cases,Roux-Y esophagojejunostomy in 29 cases,jejuna pouch and interposition in 30 cases.Results Postoperative complications occurred in 18 cases,including anastomosis leakage in 3 cases,pancreatic fistula in one case.Postoperative heartburn occurred in 21 cases,dumping syndrome in 18 cases,epigastria fullness in 15 cases,diarrhea in 12 cases,dysphasia in 9 cases.Conclusion Jejunal pouch and interposition reconstruction is the ideal procedure in improving the postoperative symptoms and the quality of life after total gastrectomy.

关 键 词：全胃切除术 胃肿瘤 间置空肠加袋术 

分 类 号：R735.2[医药卫生—肿瘤]