全胃切除功能性空肠代胃术68例临床分析.docVIP

全胃切除功能性空肠代胃术68例临床分析[摘要] 目的:分析全胃切除术后功能性空肠代胃作消化道重建手术方式的疗效。方法: 回顾性分析2003年1月～2007年12月施行全胃切除功能性空肠代胃术68例患者的临床资料。结果:部分病例出现轻度反流性食管炎、消化不良或肠功能障碍,均可缓解。所有患者术后体重、血红蛋白、清蛋白、总蛋白量均增加。结论:全胃切除功能性空肠代胃术是一种安全可靠、效果满意的手术方式。 [关键词] 全胃切除术;功能性空肠代胃术;消化道重建 [中图分类号] R656.6[文献标识码]A [文章编号]1673-7210(2010)02(c)-044-03 Analysis of functional jejunal anastomosis after total gastrectomy for 68 patients ZHAN Jianwei, SU Guosen (Department of Oncology Surgery, the People’s Hospital of Gaozhou City, Gaozhou 525200, China) [Abstract] Objective: To study the postoperative reconstruction of functional jejunal anastomosis after total gastrectomy. Methods: From January 2003 to December 2007, 68 patients who were received reconstruction of functional jejunal anastomosis after total gastrectomy were retrospectively analyzed. Results: The least symptoms with reflux esophagitis, dyspepsia or gastrointestinal dysfunction were occurred in some patients, and could be relieved after symptomatic treatment. The nutrition indicators with patients body weight, hemachrome, blood albumin, serum total protein were improved. Conclusion: The functional jejunal anastomosis is a safe and effective surgery method, and is optimum after total gastrectomy. [Key words] Total gastrectomy; Functiond jejunal anastomosis; Reconstruction of alimentary tract 胃癌是我国常见的恶性肿瘤,根治手术是首选治疗,而大部分可手术患者就诊时癌肿已浸润深肌层或浆膜层,甚至已浸润全胃黏膜下层(皮革胃),很多根治性手术需行全胃切除。施行全胃切除术时须考虑消化道重建问题,目前认为理想的术式应达到[1-2]:①重建一个具有一定容量的代胃,以增加食物储存,延缓食物排空;②尽可能按正常生理通道使食物通过十二指肠,刺激十二指肠黏膜及胰液、胆汁的分泌,以改善术后营养不良;③防止术后出现反流性食管炎、倾倒综合征等并发症。目前全胃切除术后消化道重建术式多达50余种,根据是否通过十二指肠、是否有储袋等主要有以下几种基本类型[3-4]:①食管十二指肠吻合;②食管空肠袢式吻合;③Roux-en-Y空肠食管吻合;④肠段间置术,等等,且各有其优缺点。参考不断改良的术式,我院开展全胃切除后给予功能性空肠代胃作消化道重建,取得了较好的效果。现将全胃切除功能性空肠代胃术的68例病例资料统计分析如下: 1 资料与方法 1.1 一般资料 2003年1月～2007年12月于我院施行全胃切除功能性空肠代胃术的患者68例,其中,男41例,女27例;年龄41～69 岁,平均50.6岁;胃底及贲门区肿瘤15例,胃体肿瘤48例,皮革胃5例,均属进展期;Ⅱ期16例,Ⅲ期52例;均为初次手术治疗。 1.2 手术方法 均经腹行D2或D3手术,其中15例行联合脏器切除:合并脾切除者9例,合并脾、胰体尾切除者6例。消化道重建:距Treitz韧带25～30 cm处与食管在结肠前行食管空肠端侧吻合;距食管空肠吻合口35 cm输