腹腔镜胃上部癌根治术残胃空肠双通道重建  

Remnant stomach-jejunal dual pathways reconstruction after laparoscope-assisted radical proximal gastrectomy

作　　者：钱锋[1] 唐波[1] 石彦[1] 赵永亮[1] 罗华星[1] 孙刚[1] 莫敖[1] 余佩武[1] 

机构地区：[1]第三军医大学西南医院普外科、微创胃肠外科中心,重庆400038

出　　处：《中华消化外科杂志》2008年第3期174-176,共3页Chinese Journal of Digestive Surgery

基　　金：全军“十一五”计划课题资助项目（06MB240）;重庆市医学重点学科建设资助项目

摘　　要：目的探讨腹腔镜胃上部癌根治术残胃空肠双通道重建的价值。方法对25例胃上部癌患者行腹腔镜近端胃大部根治性切除，保留远端残胃，行空肠残胃侧侧吻合、空肠空肠端侧吻合的双通道消化道重建术。结果手术平均时间（240±35）min，切缘阴性，平均清扫淋巴结（22±5）枚，无吻合口漏及狭窄、梗阻等并发症。术后均行钡餐造影，显示大部分钡剂直接进入空肠，少部分经过残胃一十二指肠进入空肠，并在残胃中滞留30～60min，无钡剂反流入食管。随访4～18个月，患者无明显反流性食管炎表现，近期生活质量满意。结论残胃空肠双通道重建术清扫、切除范围合理，残胃有一定储袋作用，能较好地预防反流性食管炎和倾倒综合征；保留了十二指肠径路，提高了患者生活质量，是胃上部癌根治术较理想的消化道重建方式。Objective To investigate the value of remnant stomach-jejunal dual pathways reconstruction after laparoscope-assisted radical proximal gastrectomy in the treatment of upper gastric cancer. Methods Twenty-five patients with upper gastric cancer underwent laparoscope-assisted radical proximal gastrectomy and the remnant distal stomach was preserved for side-to-side remnant stomach-jejunal anastomosis and end-to-side jejuno- jejunal anastomosis to reconstruct dual pathways. Results The mean operation time was （240± 35） minutes, the mean number of lymph nodes dissected were 22 ± 5, and all the incised margins were negative. No anastomotic leakage, obstruction or stenosis occurred. All patients received postoperative barium meal examination. A large amount of barium directly entered the jejunum, leaving a small amount of barium entered the jejunum via the route of remnant stomach-duodenum, and was detained in the remnant stomach for 30-60 minutes. No esophageal reflux of barium was observed. All the patients were followed up for 4-18 months, no reflux esophagitis was detected and the short-term life quality was satisfactory. Conclusions Remnant stomach-jejunal dual pathways reconstruction prevents the reflux esophagitis and dumping syndrome, preserves the pathway of duodenum and promotes the life quality of patients.

关 键 词：胃肿瘤 腹腔镜 消化道重建 

分 类 号：R735.2[医药卫生—肿瘤]