近端胃大部分切除术后改良间置空肠吻合的临床应用研究  

Study on the digestive reconstruction with jejunal interposition after proximal gastrectomy

作　　者：陈勇 徐国良 潘锋 

机构地区：[1]临安市中医院外科,临安市肿瘤防治办公室,311300

出　　处：《浙江医学》2010年第12期1770-1772,共3页Zhejiang Medical Journal

摘　　要：目的 探讨近端胃癌行近端胃大部切除后理想的消化道重建方式.方法 对60例近端胃癌患者行根治性近端胃大部分切除后采用两种常用的消化道重建术式：食管与胃直接吻合31例（直接吻合组）,食管与胃之间空肠间置吻合29例（间置吻合组）.对两种重建术的手术时间、术中出血量、术后并发症、术后1年吻合口狭窄发生率、反流性食管炎发生率及营养状况进行比较.结果 与直接吻合组比较,间置吻合组手术时间显著延长（P＜0.01）,但术中出血量、术后并发症发生率两组的差异无统计学意义（均P＞0.05）;术后1年间置吻合组反流性食管炎发生率较直接吻合组明显降低（P＜0.01）,而吻合口狭窄发生率及营养状况两组间的差异无统计学意义（均P＞0.05）.结论 食管残胃间空肠间置吻合是近端胃大部分切除后较为合适的消化道重建术式.Objective To explore the ideal way of digestive tract reconstruction after proximal subtotal gastrectomy. Methods Two types of digestive reconstruction were used in 60 patients with the proximal stomach after proximal gastric cancer radical resection： Anastomosis with esophagus and stomach directly was performed in 31 cases （Anastomosis Group）,Jejunal in- terposition between esophageal and gastric was done in 29 cases （Interposision group）. The operative time of digestive recon- struction, bleeding volume, post-operative complications and the rate of anastomostic stenosis, reflux esophagitis and nutritional status were compared. Results Compared with the Anastomosis group, the operative time of the interposition group was signifi- cantly longer （P〈0.01）. But the volume of bleeding, the incidence of postoperative complications were not significantly different between the two groups. However the rate of reflux esophagitis was significantly reduced in the interposition Group （P〈0.01）, and the rate of anastomostic stenosis and nutritional status between the two groups was no significant difference （P〉0.05）. Conclusion Jejunum interposition between esophagus and gastric remnant is a more ideal way of digestive tract reconstruction after proximal subtotal gastrectomy.

关 键 词：胃肿瘤 消化道重建 胃切除 近端胃癌 

分 类 号：R735.105[医药卫生—肿瘤]