摘要
非离断(Uncut)Roux-en-Y吻合术是目前远端胃癌根治术后应用比较广泛的消化道重建术式。但是,其输入袢近端空肠闭合点再通是患者术后随时间延长而易出现的重要并发症,引起的胰液或胆汁反流,可导致残胃或食管发生炎性病变。吻合时闭合点位置选择不佳,使盲袢中大量沉积食物受到推挤冲击以及丝线松脱、U型缝钉脱落等因素,均可导致再通并发症的发生。多数学者认为,空肠管闭合点缩短至距残胃空肠吻合口2~3 cm处位置最佳,可明显减少食物滞留量,减轻闭合点压力,降低再通率。目前,腹腔镜下四排、六排U型缝钉和7号丝线束扎等新的吻合技术和材料的应用,可预防闭合点再通的发生,Uncut Roux-en-Y安全、并发症少,有望成为消化道重建的最佳方式之一。
Uncut Roux-en-Y anastomosis is widely used in gastrointestinal reconstruction procedure after radical gastrectomy for distal gastric cancer.However,the proximal jejunal closure point recanalization of the input loop is an important complication of postoperative patients with prolonged time,resulting in pancreatic juice or bile reflux,which can lead to inflammatory lesions of the remnant stomach or esophagus.Poor selection of the location of the closure point during anastomosis causes a large amount of food deposited in the blind loop to be pushed and impacted,resulting in loosened threads or failed U-shaped staples,which may cause recanalization complications.Most scholars believe that the shortening of the jejunal tube closure point to the optimal position of 2 to 3 cm from the residual gastrojejunostomy can significantly reduce food retention,decrease the pressure of the closure point and the incidence of recanalization.At present,the application of new anastomotic techniques and materials such as four-row and six-row U-shaped staples and 7#wire ligation under laparoscopy can prevent the occurrence of recanalization of the closure point.Uncut Roux-en-Y anastomosis is safe and has few complications,and is expected to become one of the best ways of digestive tract reconstruction.
作者
朱光旭
曲建军
周升洁
Zhu Guangxu;Qu Jianjun;Zhou Shengjie(Clinical Medical College of Weifang Medical College,Weifang,Shangdong 261053,China;Department of Oncology,Weifang Peoples Hospital,Weifang,Shangdong 261000,China;Department of Anesthesiology,Weifang People′s Hospital,Shangdong Weifang,Shangdong 261000,China)
出处
《中华胃肠外科杂志》
CAS
CSCD
北大核心
2020年第7期717-719,共3页
Chinese Journal of Gastrointestinal Surgery
基金
山东省医药卫生科技发展计划项目(2017WSA07019)。
关键词
胃肿瘤
远端胃癌根治术
Uncut
Roux-en-Y吻合
闭合点再通
Stomach neoplasms
Radical surgery for distal gastric cancer
Uncut Roux-en-Y anastomosis
Recanalization of closed point
