胃癌远端胃切除术后消化道重建手术方式的选择及临床评价

Options and clinical evaluation of digestive tract reconstruction after distal gastrectomy for gastric cancer

  • 摘要: 胃癌远端胃切除术后消化道重建可选择Billroth Ⅰ式胃十二指肠吻合术、Billroth Ⅱ式胃空肠吻合术、RouxenY胃空肠吻合术、非离断式RouxenY重建、双通路重建以及空肠间置术。Billroth Ⅰ式胃十二指肠吻合术是临床最常用的消化道重建手术方式,其主要优点是保持了食物正常的十二指肠通路。与RouxenY胃空肠吻合术比较,Billroth Ⅱ式胃空肠吻合术最主要的缺点是可能发生倾倒综合征。与Billroth Ⅰ式胃十二指肠吻合术比较,RouxenY胃空肠吻合术虽可显著降低术后反流性残胃炎、反流性食管炎的发生率,但在保持体质量及改善营养状态方面并不具备优势。非离断式RouxenY重建在预防Roux潴留综合征方面优于RouxenY胃空肠吻合术。双通路重建在具备了降低反流性残胃炎、反流性食管炎发生率优点的同时,又保持了食物正常十二指肠通路。空肠间置术基本克服了上述消化道重建方式的缺点,但操作复杂,手术时间长,术后可能发生吻合口溃疡。

     

    Abstract: Digestive tract reconstruction after distal gastrectomy for gastric cancer includes Billroth〖KG*3〗Ⅰ (B〖KG*8〗Ⅰ), Billroth Ⅱ (BⅡ), RouxenY (RY), uncutRY, RYdouble tract (DT) and jejunal interposition (JI). BⅠreconstruction is the most common method, with an advantage of keeping normal duodenal pathway for food. The disadvantage of BⅡ reconstruction is that it could cause dumping syndromerelated syndroms compared with RY reconstruction. RY reconstruction was not superior to BⅠ reconstruction in terms of keeping body weight and improving nutritional status, although it could significantly decrease the incidences of reflux residual gastritis and reflux esophagitis. UncutRY reconstruction is better than RouxenY reconstruction in the prevention of Roux stasis syndrome. DT reconstruction has not only the advantages of descending the incidences of reflux residual gastritis and reflux esophagitis but also kept the normal duodenal pathway for food. JI is feasible and safe with the advantages as mentioned above, however, it has complicated surgical process and timeconsuming, and anastomotic ulcer may occur after the surgery.

     

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