摘要
目的探讨全胃切除术后消化道重建方式与患者预后的关系。方法研究分析1984年10月至2000年10月我科收治的300例全胃切除患者的部分临床资料包括手术前后体重、血红蛋白、血浆蛋白的变化及术后反流性食管炎的发生率等,并在各种消化道重建方式进行比较。结果本组胃癌280例胃恶性淋巴瘤15例胃平滑肌肉瘤5例。消化道重建采用4种方式Omega、RouxenY、RouxenY伴有“9”形袋状和与十二指肠直接吻合。30d内手术死亡8例27%1、3、5年生存率分别为700%,333%和183%。采取Omega及十二指肠直接吻合方式的患者全部发生反流性食管炎,而RouxenY与RouxenY加“9”吻合方式反流性食管炎发生率1、3、5年分别为49%和49%、30%和35%、15%和20%。Omega与十二指肠直接吻合者体重、血红蛋白、血浆蛋白较RouxenY与RouxenY加“9”吻合者明显降低。RouxenY方式吻合口瘘发生率为22%,明显低于RouxenY加“9”吻合方式(60%)。结论全胃切除后消化道重建时,简单RouxenY术式优于其他术式。
Objective To investigate the relationship between the reconstructive procedure o f alimentary tract and the prognosis a fter total gastrectomy.Methods From October 1984to October 2000,300patients underwent total gastre ctomy,whose clinical data were analyzed,including body weight,hemoglobin,plasma protein and incidence of reflux esophagitis of pre-a nd post-operation.These data were compared among the procedures.Results All 280cases with gastric cancer,15with malignant gastric lymphoma and 5with gastric smooth mu scle sarcoma were diagnosed.There were 4reconstructive procedures:Omega anastomosis,esophagoduodenostomy (EDS),simple Roux-en-Y loop and Roux-en-Y loop with“9”pouch.Eight patients(2.7%)died during postoperative period(30days).1-,3-,5-year survival rates were70.0%,33.3%and 18.3%respectively.Reflux esophagitis was more common in Omega and EDS groups than that in Roux-en-Y loop and Roux-en-Y loop plus“9”pouch groups .Body weight,plasma pr oteins and hemoglobin decreased significantly in Omega and EDS than that in Roux-en-Y loop and Roux-en-Y loop plus“9”pouch group.The incidence of anasto motic fistula increased significan tly in Roux-en-Y loop plus“9”pouch group(6%)than that in Roux-en-Y loop group(2.2%).Conclusion Simple Roux-en-Y loop is better than other procedures in the reconstruction of alimentary tract after total gastrectomy.
出处
《中华胃肠外科杂志》
CAS
2001年第3期172-174,共3页
Chinese Journal of Gastrointestinal Surgery
关键词
胃肿瘤
全胃切除术
消化道重建术
Gastric neoplasm
Total gastrectom y
Reconstructive alimentary tract
