全胃切除后食管-空肠Roux-en-Y吻合中带血管弓单管空肠的应用  

Application of Arch-Preserved Jejunum in Total Gastrectomy with Roux-en-Y Esophagojejunostomy

作　　者：陈心足[1] 张维汉[1] 伍斌[1] 张波[1] 陈志新[1] 陈佳平[1] 周总光[1] 胡建昆[1] 

机构地区：[1]四川大学华西医院胃肠外科中心,四川成都610041

出　　处：《中国普外基础与临床杂志》2013年第6期600-603,共4页Chinese Journal of Bases and Clinics In General Surgery

基　　金：国家自然科学基金(项目编号:81071777);国家教育部新世纪优秀人才支持计划(项目编号:2012SCU-NCET-11-0343);中央高校基本科研业务费专项资金;四川大学优秀青年学者科研基金(项目编号:2011SCU04B19)~~

摘　　要：目的探讨带血管弓单管空肠在食管胃结合部腺癌和胃中上部癌行全胃切除后食管-空肠Roux-en-Y吻合中处理吻合口张力的可行性。方法回顾性分析2012年12月至2013年4月期间,笔者所在医院应用带血管弓单管空肠处理食管胃结合部腺癌和胃中上部癌行全胃切除后食管-空肠Roux-en-Y吻合中吻合口张力过高问题的13例患者的临床资料,总结手术体会。结果吻合前空肠上提最大延长长度为(7.75±1.75)cm(4～10 cm),吻合后空肠上提实际延长长度为(5.95±1.82)cm(3～9 cm),延长长度实际使用率为(77.91±16.60)%(50.0%～100.0%)。术后发生急性尿储留1例,发生左肝下间隙脓肿、腹腔感染1例,无手术死亡或严重术后并发症如吻合口漏、吻合口狭窄、腹腔出血等病例。结论带血管弓单管空肠技术能够有效安全地延长空肠系膜长度,从而降低吻合口张力。该技术在临床实践中简便易行,在遇到吻合口有潜在张力风险时可考虑采用。Objective To explore the feasibility of arch-preserved jejunum in total gastrectomy with Roux-en-Y esophagojejunostomy for adenocarcinoma of esophagogastric junction（AEG）and upper-middle gastric cancer.Methods Clinical data of 13 patients who underwent total gastrectomy with Roux-en-Y esophagojejunostomy with usage of archpreserved jejunum to resolve the anastomosis tension problem in our hospital from Dec.2012 to Apr.2013 were analyzed retrospectively,and surgical experience was summarized.Results The maximal and actual extended lengths were（7.75±1.75）cm（4-10 cm）and（5.95±1.82）cm（3-9 cm）respectively,with the utilization percentage of（77.91± 16.60）%（50.0%-100.0%）.These patients hadn’t suffered postoperative mortality and severe complications,such as anastomosis leakage,stenosis,hemorrhage,and so on.Besides,there were 1 case complicated with postoperative acute urinary retention and another 1 case complicated with infra-hepatic space abscess and peritoneal infection.Conclusion Arch-preserved jejunum is a practical surgical technique to handle with the anastomosis tension of esophagojejunostomy in total gastrectomy for AEG and upper-middle gastric cancer.

关 键 词：带血管弓单管空肠 食管胃结合部腺癌 胃中上部癌 全胃切除 食管-空肠Roux-en-Y吻合 

分 类 号：R735.2[医药卫生—肿瘤]