胃切除术后消化道重建方式的合理选择及评价  

Upper digestive tract reconstruction methods:reasonable option and evaluation

作　　者：季加孚[1,2] 季鑫[1,2] 

机构地区：[1]北京大学肿瘤医院 [2]北京市肿瘤防治研究所胃肠肿瘤外科恶性肿瘤发病机制及转化研究教育部重点实验室,北京100142

出　　处：《中国实用外科杂志》2012年第8期603-605,共3页Chinese Journal of Practical Surgery

摘　　要：虽然上消化道重建方式多种多样,但目前尚无被公认的最佳重建方式。上消化道重建后,一方面必须控制好并发症的发生率;另一方面要保证病人有满意的营养状态和良好的生存质量。胃癌根治术后的重建方式也是专家们一直讨论和研究的热点,一直受到大家的重视。全胃切除术后,Roux-en-Y吻合是一种简单、并发症少,又能满足功能要求的重建方式。对病期晚、预后差的进展期胃癌病人,Roux-en-Y吻合时不建议附加贮袋,对于良性肿瘤或者早期胃癌,可以附加重建贮袋,以期提高生存质量。远端胃大部切除术后,相对于BillrothⅠ式吻合来说,BillrothⅡ式或Roux-en-Y吻合重建术并发症少、肿瘤复发率低。BillrothⅠ式吻合重建的适用范围较为有限。近端胃大部切除术后,采用食管残胃(管状胃)吻合是较为常见的重建方式。幽门重建的作用还存在一定争议,有待进一步研究。Several reconstruction techniques are possible after gastrectomy. But the best reconstruction technique hash＇ t been admitted yet by now. The best reconstruction should meet the condition of maintaining satisfactory nutritional status and quality of life meanwhile keeping postoperative morbidity as low as possible. After total gastrectomy, Roux-en-Y reconstruction remains the easiest solution with satisfactory functional results and less complication. A pouch reservoir is suggested to make for patients with benign tumor and early gastric cancer, not for patients with advanced tunmr and poor prognosis, during Roux-en-Y reconstruction. After distal gastrectomy, Billroth ]1 or Roux-en-Y reconstruction should be preferred over Billroth I reconstruction because of lower postoperative morbidity and better oncologic margins. After proximal gastrectomy, esophagogastric anastomosis is the basic reconstruction method. Gastric remnant is made into gastric tube in the operation. The effect of pyloroplasty remains controversial. The further study is needed to improve the quality of life after operation.

关 键 词：上消化道重建 贮袋 胃切除术 

分 类 号：R6[医药卫生—外科学]