改良胃空肠Roux—en—Y吻合术席用观察

目的观察改良胃空肠Roux—en-Y吻合术的应用效果。方法将43例需行胃切除不宜做毕术式的患者随机分为改良组28例和对照组15例,改良组采用改良胃空肠Roux—en—Y吻合术,对照组采用标准胃空肠Roux-en-Y吻合术。结果改良组手术时间为（260±50）min,术中出血（280±80）ml;对照组分别为（300±70）min、（350±90）ml。两组比较,P均〈0．05。术后随访11～24个月,平均18个月,对照组出现吻合口瘘4例,Roux潴留综合征7例,倾倒综合征1例,碱性反流性胃炎1例,改良组分别为0、1、1、1例。两组术后吻合口瘘、Roux潴留综合征比较,P均〈0．05。结论改良胃空肠Roux-en—Y吻合术所需手术时间缩短、创伤小,且术后并发症少。     

胰管空肠Roux—en—Y吻合术治疗胰管结石

胰管结石临床较为少见,发病率不超过1%。近年来,随着医学影像学的发展,胰管结石的病例明显增多,我院1990 年1月至2004年6月共收治胰管结石患者9例,行胰管切开取石、胰管空肠Roux-ez-Y吻合术8例。现报告如下。资料与方法一、一般资料本组8例中男6例,女2例。年龄14-66岁,平均年龄为42.6岁。病程1-6年。上腹部疼痛8例,脂肪泻和消瘦5例, 黄疸1例,糖尿病4例,反复消化道出血1例,上腹部压痛8 例,上腹部包块1例。     

胆肠Roux—en—Y吻合的形态与返流的关系

将６０例施行胆肠Ｒｏｕｘ－ｅｎ－Ｙ吻合的患者分为两组，对照组按传统方法吻合，改良组则将上行肠袢短至２５～３０ｃｍ，近侧肠袢１５～２０ｃｍ，同步缝合延长至１０～１２ｃｍ。术后３０～９０天行２～３次上消化道钡透。结果：符合Ｙ形３８例（改良组２６例，对照组１２例），返流３例（７．９％）；非Ｙ形２２例，返流１４例（６３．６％）。提示改良法Ｒｏｕｘ－ｅｎ－Ｙ吻合更符合Ｙ形态，符合Ｙ形者有较好的抗返流效果（Ｐ     

胃大部切除胃空肠Roux—y吻合术治疗溃疡病

我院自1985～1987年行胃大部切除、胃空肠Roux-y吻合治疗溃疡病25例,报告如下。1.手术方法:胃大部切除,小弯侧封闭,十二指肠残端封闭,距屈氏韧带10～15厘米处离断肠系膜血管及空肠,远端封闭,将远端空肠自横结肠系膜裂孔与残胃作胃空肠端侧吻合,再将近端空肠在距胃空肠吻合口25厘米处作空肠端侧吻合。2.结果:全部病例术后均恢复顺利,无并发     

胃手术与胃运动

胃手术与胃运动温晖ＳｕｂｊｅｃｔｈｅａｄｉｎｇｓＰｏｓｔａｓｔｅｃｔｉｎｇｓｙｎｄｏｍｅｓＤｕｍｐｉｎｇｓｙｎｄｒｏｍｅｓＳｔｏｍａｃｈ／ｓｕｒｇｅｒｙＧａｓｔｒｏｉｎｔｅｓｔｉｎａｌｍｏｔｉｌｉｔｙＧａｓｔｒｅｃｔｏｍｙ主题词胃／外科学胃切除...     

Roux‑en‑Y吻合术后内镜逆行胰胆管造影术选择性插管的方法对比（含视频）

目的　比较Roux‑en‑Y吻合术后采用双人操作法和三人操作法行内镜逆行胰胆管造影术（endoscopic retrograde cholangiopancreatography, ERCP）的安全性和有效性。方法　将杭州市第一人民医院消化内科2021年1月至2022年9月进镜成功、找到十二指肠乳头的31例Roux‑en‑Y吻合术后胆总管结石患者纳入研究对象。采用回顾性研究的方法,2021年1—12月采用双人操作法（即一名操作医师和一名助手完成选择性插管操作）行ERCP的17例患者纳入A组,2022年1—9月采用三人操作法（即一名操作医师和两名助手完成选择性插管操作）行ERCP的14例患者纳入B组。比较两组插管成功率、插管时间和并发症发生率。结果　所有入组患者插管成功率为90.32%（28/31）,其中A组插管成功率为82.35%（14/17）,B组插管成功率为100.00%（14/14）,两组患者插管成功率比较差异无统计学意义（P=0.232）。B组插管时间明显低于A组［（42.89±6.57）min比（61.02±9.23） min］,差异有统计学意义（t=5.77,P<0.001）。所有入组患者ERCP术后并发症发生率为16.13%（5/31）,A组和B组分别为17.65%（3/17）和14.29%（2/14）,差异无统计学意义（P=1.000）。结论　对于Roux‑en‑Y吻合术后并发胆总管结石行ERCP患者,两种方法在插管成功率和手术相关并发症发生率方面相当,但在操作时间方面三人操作法具有明显优势。     

胃近端保留倒置食管胃空肠Y式吻合术在食管胃双原发癌治疗中的应用

2005年3月以来,我院收治食管胃重复癌2例,在诊断治疗过程中,我们采用了一种新的术式,称之为胃近端保留倒置食管胃空肠Y式吻合术。现介绍如下。     

胆肠Roux—Y吻合术对胃酸分泌功能影响的临床研究

本研究对两种胆肠Roux—Y吻合术(端侧吻合和侧侧吻合)后34例病人做平均4年7个月的随防观察,并对14例胆肠Roux—Y吻合术前术后的胃酸分泌情况进行了比较。结果表明:端侧吻合术后胃酸明显增高,但其数值仍属正常;而侧侧吻合术后胃酸无明显增高;无一例消化性溃疡。本研究认为:此术式术后消化性溃疡临床并不常见。     

全胃切除空肠代胃术式的探讨

目的观察、总结和分析全胃切除后Lahey术式与Nadrowski推荐术式临床疗效.方法选择经医师直接随访复查6M～1Y的全胃切除后饮食量、体力恢复、后遗症及并发症等项目,评定疗效.结果Lahey术34例中,吻合口瘘2例,肺部感染3例,吻合口狭窄4例,腹壁裂开、腹腔感染3例,并发症发生率为35.2%;Nadrowski推荐术式18例中仅吻合口瘘1例,经1M治疗痊愈出院,并发症发生率为5.5%,两者差异显著(P<0.05);前者正常饮食量22例,体力恢复19例,反流性食管炎24例,营养不良18例,腹泻7例;后者分别为16,15,0,1,0,两者除"体力恢复”无显著差异外,其余各项均有显著差异(P<0.05～0.01).结论Nabrowski推荐术式优于Lahey术式,是本世纪初以来所介绍的最有营养前途而操作简单的一种替代胃手术.     

全胃切除后消化道重建术P-SS吻合法

目的作者集中"P”形袢SS吻合法二者优点,简称P-SS吻合法,应用于全胃切除后消化道重建术.本组21例,术后无一例吻合口瘘、狭窄,无反流性食管炎等并发症,提高患者术后生活质量,是值得推荐基层医院开展全胃切除后消化道重建有效的术式.     

胃次全切除术后早期肠内营养对胃肠动力的影响

目的 观察胃次全切除术后早期给予肠内营养对胃肠动力的影响。方法 将1999年12月至2001年2月接受手术治疗的进展期胃癌患者共18例随机分成肠内营养组和对照组各9例，分别给予术后早期肠内营养和普通治疗。应用Synectics MicroDigitrapper动态测压仪及配套的Polygram软件记录、分析、比较两组术后胃肠动力波形的变化，记录术后并发症等情况。结果 胃切除术后早期所有患者的移行性复合运动(MMC)均消失，术后第一个MMC出现的时间为34min～4h不等，两组相比差异无显著性。术后早期MMC的表现与正常MMC有明显不同：缺乏MMCⅡ相，仅由Ⅰ相和Ⅲ相构成；72h内MMC的周期变异逐步趋于一致。观察期内偶见逆向传导的MMC。肠内营养组的MMCⅢ相持续时间(TIME)、曲线下面积(AREA)、传导速度(V)、动力指数(MI)四项指标均高于对照组，两组比较差异有显著性。两组的术后并发症比较差异无显著性。结论 胃次全切除术后早期实施肠内营养可加速MMC的传导，改善MMC的收缩活动，促进胃肠动力的恢复。     

Long loop Roux-Y esophagojejunostomy following total gastrectomy.

Excellent results were obtained with total gastrectomy in 42 patients having received one-layer esophagojejunostomy by hand-suturing. This is a safe and easy technique to use and therefore we use it from 1971 in all patients undergoing total gastrectomy.     

Systematic review of anastomotic complications of esophagojejunostomy after laparoscopic total gastrectomy

AIM: To investigate the anastomotic complications of esophagojejunostomy (EJS) after laparoscopic total gastrectomy (LTG), we reviewed retrospective studies.METHODS: A literature search was conducted in PubMed for studies published from January 1, 1994 through January 31, 2015. The search terms included “laparoscopic,” “total gastrectomy,” and “gastric cancer.” First, we selected 16 non-randomized controlled trials (RCTs) comparing LTG with open total gastrectomy (OTG) and conducted an updated meta-analysis of anastomotic complications after total gastrectomy. The Newcastle-Ottawa scoring system (NOS) was used to assess the quality of the non-RCTs included in this study. Next, we reviewed anastomotic complications in 46 case studies of LTG to compare the various procedures for EJS.RESULTS: The overall incidence of anastomotic leakage associated with EJS was 3.0% (30 of 984 patients) among LTG procedures and 2.1% (31 of 1500 patients) among OTG procedures in the 16 non-RCTs. The incidence of anastomotic leakage did not differ significantly between LTG and OTG (odds OR = 1.42, 95%CI: 0.86-2.33, P = 0.17, I² = 0%). Anastomotic stenosis related to EJS was reported in 72 (2.9%) of 2484 patients, and the incidence was 3.2% among LTG procedures and 2.7% among OTG procedures. The incidence of anastomotic stenosis related to EJS was slightly, but not significantly, higher in LTG than in OTG (OR = 1.55, 95%CI: 0.94-2.54, P = 0.08, I² = 0%). The various procedures for LTG were classified into six categories in the review of case studies of LTG. The incidence of EJS leakage was similar (1.1% to 3.2%), although the incidence of EJS stenosis was relatively high when the OrVil^TM device was used (8.8%) compared with other procedures (1.0% to 3.6%).CONCLUSION: The incidence of anastomotic complications associated with EJS was not different between LTG and OTG. Anastomotic stenosis was relatively common when the OrVil^TM device was used.     

Intracorporeal esophagojejunostomy using the double stapling technique after laparoscopic total gastrectomy:A retrospective case-series study

AIM:To introduce a simple and safe anvil insertion technique to esophagus during laparoscopic total gastrectomy(LTG).METHODS:Between July 2010 and December 2012,58 consecutive patients with early gastric cancer underwent LTG were enrolled.We performed a simple and safe Roux-en-Y esophagojejunostomy using the double stapling technique to all patients.Then patients’characteristics,perioperative outcome and histopathologic data were analyzed retrospectively.RESULTS:The mean age and body mass index were59.3±9.7 years and 22.7±2.6 kg/m2.The mean operation,reconstruction and anvil insertion times(from gastric incision to linear stapling)were 251.8±57.0,43.1±2.8 and 4.2±1.9 min,respectively.Intraoperative blood loss was 204.6±156.3 m L and there was no open conversion.The postoperative complications were in 8 cases(delayed gastric emptying in 4 cases,pulmonary complication in 2cases,pancreatitis in 1 case,anastomotic stricture in 1case).Anastomotic stricture occurred after discharge and was recovered by endoscopic intervention.The patients were discharged at a mean of 9.6±2.0 d after surgery.Neither leakage nor bleeding from the esophagojejunostomy occurred postoperatively.The mean proximal margin of specimen was 2.7±2.8 cm CONCLUSION:Roux-en Y esophagojejunostomy usingthe double stapling technique is simple and rapid,and it may offer a solid,alternative reconstruction method for LTG or proximal gastrectomy.     

Elenoside increases intestinal motility

INTRODUCTION A great number of arylnaphthalene lignans have been isolated from different species of Justicia, many of them exhibiting diverse biological activities including antitumoral[1-4], antiviral[5-7], insecticidal[8], cardiotonic[9,10], antiulcerog…     

Roux-limb motility after total gastrectomy and Roux-en-Y anastomosis in patients with zollinger-ellison syndrome

The Roux-en-Y syndrome was defined as chronic nausea, intermittent vomiting, and chronic abdominal pain worsened by eating in patients who have undergone a gastrojejunostomy Roux-en-Y reconstruction for peptic ulcer. When these patients fasted, the Roux limb showed striking abnormalities in motor function; when postprandial, they failed to convert to normal fed-state motor activity. In contrast, patients with Zollinger-Ellison syndrome do well after similar surgery; they can eat most foods and maintain their body weight. We studied the motility of the Roux limb and jejunum in six patients with Zollinger-Ellison after an esophagojejunostomy Roux-en-Y anastomosis. Roux-limb motor activity in these patients, as characterized by the migrating motor complex, was more frequent, well organized, and in synchrony with the remaining jejunum; most subjects also converted to the fed state after a liquid meal. We suggest that the enteric nervous system is intact and functions normally in patients who have had a Roux-en-Y reconstruction for ulcer disease secondary to Zollinger-Ellison, but not in patients with idiopathic peptic ulcer disease.This work was supported in part by the National Institutes of Health Clinical Research Center grant RR-00073.This material was published in abstract from (Gastroenterology 98:A366, 1990) and presented as posters at the meetings of the American Gastroenterological Association., San Antonio, Texas, 1990, and the North American Conference of Gastroenterology Fellows, San Diego, California, 1991.     

创伤性脑损伤大鼠肠黏膜损害及小肠运动功能障碍的关系研究

目的观察创伤性脑损伤（TBI）后大鼠肠黏膜形态学改变及小肠动力变化,探讨二者的关系。方法采用改良Feeney自由落体撞击伤法建立TBI模型。64只雄性健康Wistar大鼠随机分为假手术对照组和TBI组,两组又根据实验终止时间各分为4个亚组,分别于伤后3、6、12、24 h光镜下观察小肠黏膜的病理变化及利用美蓝染色法计算小肠推进比。结果 TBI组小肠推进比均低于对照组（P〈0.05）。光镜下TBI组3 h即可见肠绒毛肿胀、增粗、缩短,12 h见绒毛破损、剥脱。结论 TBI后早期即可出现肠黏膜损伤和肠动力障碍,二者可能互为因果。     

胃切除后早期中药小肠内滴注对患者血液流变学的影响

２２例胃切除的患者，术中小肠内放置硅胶管，术后６～１２ｈ滴注中药（治疗组）。通过和常规方法治疗的１９例对照组比较：对照组术后３ｄ，５ｄ血液粘稠度较之术前和治疗组均明显升高（Ｐ＜０．０１～０．０５）；而治疗组血液流变学各项指标手术前后无明显变化（Ｐ＞０．０５）。认为，胃切除后中药早期应用，能够迅速促进脾胃机能恢复，脾气健旺则能推动血液运行，从而使血液粘稠状态改变。     

Myoelectric activity and motility of the Roux limb after cut or uncut Roux-en-Y gastrojejunostomy

INTRODUCTIONRoux-en-Y anastomosis is a commonly used surgical procedure in gastroenterological surgery; however, more than one third of the patients who experience such an operation suffer Roux stasis syndrome[1,2]. It has been proposed that the occurrenc…     

Gastrointestinal motility and gastric emptying after Billroth II gastrectomy in dogs

This study was undertaken to compare the effects of subtotal Billroth II gastrectomy on gastric emptying and gastrointestinal motility with previously published results in intact dogs and in dogs with subtotal Roux-Y gastrectomy. Extraluminal strain gauge transducers were used to study gastrointestinal motility after Billroth II gastrectomy in four conscious dogs. Gastric emptying was measured radiographically. In Billroth II dogs gastric emptying of low-viscosity meals was biphasic with an initial rapid emptying. The addition of nutrients to low-viscosity meals delayed gastric emptying accompanied with reduction in gastric and jejunal motility. Similar to that in Roux-Y dogs, gastric emptying of noncaloric medium-viscosity meals was delayed because of segmenting motor patterns of the jejunal loops, in contrast to the propulsive jejunal motor pattern in intact dogs. Nutrients added to medium-viscosity meals did not change the jejunal motor pattern; gastric emptying was delayed compared with intact dogs. Results show that meal viscosity and jejunal motor pattern influence gastric emptying after Billroth II gastrectomy.This study was supported by the Deutsche Forschungsgemeinschaft, grant Eh 64/3-2.