全胃切除后消化道重建方式的比较

目的探讨全胃切除术合理的消化道重建方式。方法对76例胃癌患者全胃切除术分别采用食管空肠Roux-en-Y吻合法、Lahey Braun吻合法、P型空肠袢代胃三种不同方法进行消化道重建,对其手术时间、并发症、术后饮食状况和消化道症状及营养指标进行对比观察。结果3种术式手术死亡率、术后1年的营养状况、倾倒综合征发生率比较无统计学意义。但食管空肠Roux-en-Y吻合、P型空肠袢代胃术后均能有效防止反流性食管炎,优于Lahey Braun吻合,食管空肠Roux-en-Y吻合操作简单、手术时间短、并发症也较少。结论食管空肠Roux-en-Y吻合、P型空肠袢代胃术是全胃切除后消化道重建较为合适的方法。

Comparative study of digestive reconstruction after total gastrectomy

Aim To investigate the rational digestive reconstruction after total gastrectomy for gastric malignancy.Methods Three types of digestive reconstruction were performed after total gastrectomy in 76 cases with gastric carcinoma.The operating time,morbidity and mortality,digestive tract symptoms,nutritional status in 1 year after operation were compared.Results There are no significant differences among the three procedures in operative morbidity and mortality,postoperative food intake,nutritional status,incidences of diarrhea and dumping syndrome.Roux-en-Y esophajejunostomy and P-type esophajejunostomy have an advantage of anti-esophageal reflux,and are obviously superior to Lahey Braun anastomosis.Roux-en-Y esophajejunostomy is simpler with shorter operating time and less complication.Conclusion Roux-en-Y esophajejunostomy and P-type esophajejunostomy can be recommended as suitable methods for digestive reconstruction after total gastrectomy.