非离断式Roux-en-Y吻合术在远端胃癌根治术后消化道重建的应用进展

Application progress of uncut Roux-en-Y anastomosis in digestive tract reconstruction after distal gastrectomy of gastric cancer

  • 摘要: 肿瘤切除、淋巴结清扫和消化道重建是胃癌根治术三大步骤,其中消化道重建对减少术后并发症和维持较好的生命质量至关重要。非离断式RouxenY吻合术是在Billroth Ⅱ式+Braun吻合术基础上,闭合而不离断近端空肠的改良重建手术方式,目的是减少滞留综合征的发生。与传统RouxenY吻合术比较,非离断式RouxenY吻合术不仅保留了减少胆汁和胰液反流的优势,还可减少因阻断空肠机电传导而引起的一系列并发症。由于早期基础研究中,闭合口存在较高的裂开和再通发生率,故其在临床上并未普及。近年来,由于闭合技术的优化,非离断式RouxenY吻合术在远端胃切除术中应用越来越广泛,并可能成为最佳的消化道重建方式。

     

    Abstract: Digestive tract reconstruction is an important part of gastric carcinoma operation as well as tumor resection and lymph node dissection. Surgeons are seeking the optimal reconstruction method that reduces the occurrence of complications and maintains better quality of postoperative life extremely. Uncut RouxenY anastomosis is a modified procedure in which an artificial jejunal occlusion is devised to avoid Roux stasis syndrome based on Billroth II and Braun′s anastomosis. Compared to the conventional RouxenY anastomosis, the uncut RouxenY anastomosis retains the advantage of preventing biliary and pancreatic secretions reflux, furthermore, it can decrease the symptoms associated with Roux stasis owing to the abnormal myoelectrical conduction of Roux limb. Because the early studies indicated that there was higher incidence of dehiscence or recanalization of the jejunal occlusion, the uncut RouxenY anastomosis has not been widely applied. Since jejunal occlusion has been optimized recently, the uncut RouxenY reconstruction may be an optional and appropriate method of digestive tract reconstruction after distal gastrectomy.

     

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