[1]金万亮.全胃切除代胃空肠行抗返流术式预防食道返流的研究[J].医学信息,2018,31(12):93-95,101.[doi:10.3969/j.issn.1006-1959.2018.12.028]
　JIN Wan-liang.Prevention of Esophageal Regurgitation by Total Gastrectomy for Gastric Emptying and Anti Reflux Procedure[J].Journal of Medical Information,2018,31(12):93-95,101.[doi:10.3969/j.issn.1006-1959.2018.12.028]
点击复制

全胃切除代胃空肠行抗返流术式预防食道返流的研究()
分享到：

医学信息[ISSN:1006-1959/CN:61-1278/R]

卷:
31卷
期数:
2018年12期
页码:
93-95,101
栏目:
临床研究
出版日期:
2018-06-15

文章信息/Info

Title:
Prevention of Esophageal Regurgitation by Total Gastrectomy for Gastric Emptying and Anti Reflux Procedure
文章编号:
1006-1959（2018）12-0093-04
作者:
金万亮
东莞市中堂医院普通外科，广东 东莞 523220
Author(s):
JIN Wan-liang
Department of General Surgery,Dongguan Zhongtang Hospital,Dongguan 523220,Guangdong,China
关键词:
近端胃癌根治术; 全胃切除术; 空肠抗返流瓣; 消化液返流
Keywords:
Key words：Radical gastrectomy for proximal gastric cancer; Total gastrectomy; Jejunal anti reflux flap; Digestive fluid regurgitation
分类号:
R735.2
DOI:
10.3969/j.issn.1006-1959.2018.12.028
文献标志码:
A
摘要:
目的 探讨近端胃癌行根治性全胃切除，空肠-空肠储袋胃、储袋胃的近、远端空肠行抗返流瓣术式、空场-空肠Roux-en-Y吻合术预食道返流的可行性。方法 将2003年1月~2012年12月我院收治的行近端胃癌根治手术的患者87例随机分为两组，对照组43例行全胃切除空肠储袋胃、空肠-空肠Roux-en-Y吻合的胃癌根治术，实验组44例行空肠储袋胃、储袋胃的近、远端空肠行抗返流瓣术式、空场-空肠Roux-en-Y吻合术预防食道返流，观察两组患者术后是否有吻合口狭窄、术后进食时间、肠道恢复时间、术后住院时间、钡剂停留时间。术后2个月随访营养状况，随访至6个月，根据Mettin标准评估两组患者食管黏膜组织学炎症改变、是否有反流性食管炎以及患者生存率。结果 术后两组患者恢复良好，均无吻合口狭窄。两组患者进食时间、肠道恢复时间、术后住院时间组间对比，差异无统计学意义（P＞0.05）。实验组钡剂停留时间长于对照组，差异具有统计学意义（P＜0.05）。术后2个月随访两组病例食欲良好，血红蛋白上升、体重无减轻，营养状况良好。对照组出现食管炎症改变的例数多于实验组，两组相比，统计学意义显著（P＜0.01）；对照组出现返流性食管炎例数多于实验组，差异具有统计学意义（P＜0.05）。所有患者均随访1年，1年内无患者死亡。结论 若严格的把握适应证，近端胃癌行根治性胃全切除行空肠-空肠储袋胃、储袋胃的近、远端空肠行抗返流瓣术式、空场-空肠Roux-en-Y吻合术能有效预防食道返流，可降低返流性食管炎的发生率，显著改善患者的生存质量。
Abstract:
Abstract：Objective To investigate the feasibility of radical total gastrectomy, jejunojejunal bag storage,proximal and distal jejunum with anti-reflux valve and jejunostomy with Roux-en-Y jejunostomy.Methods From January 2003 to December 2012,87 patients with proximal gastric cancer were randomly divided into two groups.The control group(43 cases)underwent radical gastrectomy with total gastrectomy and Roux-en-Y jejunostomy.In the experimental group,44 cases were treated with jejunal bag-storing stomach, proximal and distal jejunum with anti-regurgitation valve.Roux-en-Y jejunostomy was performed to prevent esophageal reflux.Postoperative anastomotic stenosis,postoperative feeding time,intestinal recovery time,postoperative hospital stay and barium retention time were observed in the two groups.Nutritional status was followed up to 6 months after 2 months.The histologic changes in the esophageal mucosa,reflux esophagitis and the survival rate of the esophageal mucosa were evaluated according to the Mettin criteria in the two groups.Results After operation,the two groups recovered well without anastomotic stenosis.There was no significant difference between the two groups in eating time,intestinal recovery time and postoperative hospitalization time(P>0.05).The retention time of barium in the experimental group was longer than that in the control group,the difference was statistically significant(P<0.05).After 2 months of follow-up,two groups of patients had good appetite,increased hemoglobin,no weight loss,and good nutritional status.The number of cases of esophageal inflammation change in the control group was more than that in the experimental group.The statistical significance of the two groups was significant(P<0.01),and the number of reflux esophagitis in the control group was more than that in the experimental group,the difference was statistically significant(P<0.05).All patients were followed up for 1 years,and no patient died within 1 years.Conclusion If the indications are strictly grasped, the proximal gastric carcinoma with radical ggastrostomy,the close to the jejunum bag stomach,the close to the bag stomach, the distal jejunum anti reflux valve and the empty jejunum Roux-en-Y anastomosis can effectively prevent the reflux of the esophagus,which can reduce the incidence of reflux esophagitis and improve the quality of life of the patients.

参考文献/References:

[1]杨文辉.Roux-en-Y与Roux-en-Y加远端空肠储袋法对胃癌全胃切除患者预后的影响研究[J].安徽医学,2016,37(6):728-730.
[2]刘永永,王琛,康迎新,等.两种消化道重建方式在腹腔镜胃癌全胃切除术后的疗效分析.中国医师进修杂志,2017,39(29):54-56.
[3]康悦,魏玉哲,薛英威.全胃切除后问置空肠代胃与Roux-en-Y吻合两种消化道重建方式远期并发症及生活质量比较的Meta分析[J].中华胃肠外科杂志,2013,16(2):135-139.
[4]高玉明.袢式空肠代胃改良术在全胃切除术后消化道重建中的应用[J].安徽医学,2014,35(11):1527-1528.
[5]梁寒.全胃切除后不同消化道重建术式对患者生活质量的影响[J].中华胃肠外科杂志,2011,14(6):403-405.
[6]Kobayashi D,Kodera Y,Fujiwara M,et al.Assessment ofquality of life after gastrectomy using EORTCQLQ-C30 and ST022[J].World J Surg,2011,35(2):357-364.
[7]Oate-Ocana LF,Alcántara-Pilar A,Vilar-Compte D,et al.Validation of the Mexican Spanish version of the EORTC C30 and STO22 questionnaires for the evaluation of health-related quality of life in patients with gastric cancer[J].Ann Surg Oncol,2009,16(1):88-95.
[8]Liang H,Hao XS.Effects of different operative procedures on the digestive and nutritional status of patients treated with agastrectomy for gastric cancer[J].Chin J Clin Oncol,2006,3(3):216-222.
[9]Ishigami S,Natsugoe S,Hokita S,et al.Postoperative long-term evaluation of interposition reconstruction compared with Roux-en-Y after total gastrectomy in gastric cancer:prospective randomized controlled trial[J].Am J Surg,2011,202(3):247-253.
[10]Kono K,lizuka H,Sekikawa T,et al.Improved quality of life with jejunal pouch reconstruction after total gastrectomy[J].Am J Surg,2003,185(2):150-154.
[11]Yanagida H,Yanase H,Sanders KM,et al.Intestinal surgical resection Disrupts electrical rhythmicity,neural responses,and interstitial cell networks[J].Gastroenterology,2004,127(6):1748-1759.
[12]吴亮亮,梁寒,张汝鹏,等.全胃切除术后四种消化道重建术式的比较分析[J].中华胃肠外科杂志,2010,13(12):895-898.
[13]Pan Y,Li Q,Wang DC,et al.Beneficial effects of jejunal continuity and duodenal food passage after total gastrectomy:A retrospective Study of 704 patients[J].Eur J Surg Oncol,2008,34(1):17-22.
[14]陈映波,李元方,冯兴宇,等.胃癌患者全胃切除术后两种消化道重建方式的比较[J].中华肿瘤杂志,2011,32(2):126-129.
[15]薛延庆.胃癌肿瘤部位对手术术式选择的探讨[J].医学信息,2013,26(20):403.

相似文献/References:

[1]赵长海,任秀敏,杨晓丹,等.腔镜辅助近端胃癌根治术对近端胃癌患者NK细胞以及T淋巴细胞影响分析[J].医学信息,2020,33(08):110.[doi:10.3969/j.issn.1006-1959.2020.08.034]
　ZHAO Chang-hai,REN Xiu-min,YANG Xiao-dan,et al.Effect of Endoscopic Assisted Radical Gastrectomy on NK Cells and T Lymphocytes[J].Journal of Medical Information,2020,33(12):110.[doi:10.3969/j.issn.1006-1959.2020.08.034]
[2]万玉峰.近端胃癌根治术中行胃食管前壁吻合的疗效及对患者胃肠功能恢复的影响[J].医学信息,2023,36(06):120.[doi:10.3969/j.issn.1006-1959.2023.06.026]
　WAN Yu-feng.Effect of Gastroesophageal Anterior Wall Anastomosis in Radical Gastrectomy for Proximal Gastric Cancer and its Effect on the Recovery of Gastrointestinal Function[J].Journal of Medical Information,2023,36(12):120.[doi:10.3969/j.issn.1006-1959.2023.06.026]

更新日期/Last Update: 2018-06-15