不同消化道重建方式与胃切除术后消化道梗阻关系  

Analysis on the relationship between methods of reconstruction after gastrectomy and digestive tract obstruction

作　　者：刘彤[1] 戚峰[1] 赵忠治 

机构地区：[1]天津医科大学总医院胃肠外科天津普通外科研究所,天津300052

出　　处：《中国实用外科杂志》2017年第4期373-377,共5页Chinese Journal of Practical Surgery

摘　　要：外科技术和手术器械的进步给胃切除术带来了各种革新,术后消化道梗阻发生原因也趋于多样化、复杂化,涉及原发疾病、术式选择、吻合方法等多种因素。术后吻合口狭窄或梗阻可发生在胃-十二指肠、胃-空肠、食管-空肠、食管-残胃等多种吻合中,与吻合方式和吻合器械的选择、瘢痕或肿瘤复发关系密切。输入袢或输出袢梗阻仍然是困扰着外科医生的重要并发症之一,输入袢问题更多见。Roux-en-Y吻合上举空肠臂也可能发生一些特有的消化道梗阻,包括上举肠臂肠管套叠、内疝、Roux滞留综合征等。此外,胃瘫、粘连性肠梗阻也时有发生。疾病谱的改变和胃肠外科的发展,使胃切除术后消化道梗阻发生原因、特点均出现了很大变化,需要临床医生发扬工匠精神,精益求精,不断总结临床经验。The progress of surgical techniques and surgical instruments has brought a variety of innovation for gastric surgery. The causes of postoperative digestive tract obstruction also become diversified, involving primary disease, choice of procedure, anastomosis method and other factors. Anastomotie stenosis or obstruction after gastreetomy mainly occurs in stomach-duodenum, stomach-jejunum, esophagus-jejunum, esophagus-residual stomach and other anastomosis, closely related to the selection of anastomosis, procedures and instruments, scar or tumor relapse. The afferent loop and efferent loop obstruction are still one of the important complications. It is more afferent loop obstruction in clinic. The Roux limb of Roux-en-Y anastomosis may also have some unique obstructions, such as intussusception, internal hernia, Roux stasis syndrome. In addition, gastric paralysis or adhesive intestinal obstruction may also occur. Therefore, with the changes in disease spectrum and the development of gastrointestinal surgery, the causes and characteristics of digestive tract obstruction after gastrectomy have undergone great changes. Surgeons need to carry forward the artisan spirit, strive for excellence, and constantly sum up clinical experience.

关 键 词：胃切除术 消化道重建 消化道梗阻 吻合 

分 类 号：R6[医药卫生—外科学]