非离断式Roux-en-Y吻合术在胃窦癌根治性远端胃大部分切除术中的应用

目的 探讨非离断式Roux-en-Y吻合术用于胃窦癌根治性远端胃大部切除术中消化道重建的临床疗效.方法 对298例胃窦癌患者行根治性远端胃大部分切除术时分别采取非离断式Roux-en-Y吻合术（193例）与离断式Roux-en-Y吻合术（105例）行消化道重建.结果 全部患者术后随访3～5年.两组术后近期内并发症发生率分别为5.7%（11/193）和15.2%（16/105）,差异有统计学意义（P〈0.01）;碱性反流性胃炎的发生率分别为0和6.7%（7/105）,非离断式Roux-en-Y吻合术组明显低于离断式Roux-en-Y吻合术组（P〈0.01）;非离断式Roux-en-Y吻合术组无Roux潴留综合征发生,而离断式Roux-en-Y吻合术组有10例（9.5%）发生Roux潴留综合征,两组差异有统计学意义（P〈0.01）;两组患者1年和3年生存率差异均无统计学意义（P〉0.05）.结论 胃窦癌患者行根治性远端胃大部分切除术采用非离断式Roux-en-Y吻合术行消化道重建明显减少了术后反流性胃炎、反流性食管炎等并发症,同时克服了传统术式易发生Roux潴留综合征的弊病,是胃大部分切除术后理想的消化道重建术式.

Application of uncut Roux-en-Y anastomosis in radical distal gastrectomy for gastric carcinoma

Objective To evaluate the application of uncut Roux-en-Y anastomosis in radical distal gastrectomy for gas- tric carcinoma. Methods One hundred and ninety eight patients with gastric carcinoma underwent uncut Roux-en-Y anastomosis and 105 patients underwent conventional Roux-en-Y anastomosis after radical distal gastrectomy. Results All patients were fol- lowed up for 3 to 5 years. The early complication rates of uncut Roux-en-Y anastomosis and conventional Roux-en-Y anasto- mosis were 5.7% （11/193） and 15.2% （16/105） （P 〈 0.01）. Alkaline reflux gastritis was 0% and 6.7%（ 7/105 ）for uncut Roux-en-Y and conventional anastomosis （P 〈 0.01）, respectively. In conventional Roux-en-Y anastomosis 10 patients （9.5%） had Roux stasis syndrome, while there is no Roux stasis syndrome in uncut Roux-en-Y anastomosis （P 〈 0.01）. There was no significant difference in 1 and 3-year survival rate between two groups. Conclusion The uncut Roux-en-Y anastomosis can reduce the complications after radical distal gastrectomy for gastric carcinoma.