全胃切除P型空肠间置原位代胃术

目的 探讨全胃切除术P型空肠间置原位代胃术的效果。方法 对15例符合全胃切除的病人，施行了全胃切除P型空肠间置原位代胃术。结果 本组无手术死亡，无切口、腹腔感染及吻合口瘘。发生反流性食管炎，进油腻性食物后恶心各1例，对症治疗缓解。15例均于术后0.5,1,6个月行钡餐检查，P型胃充盈良好，钡剂全部排空时间3－4h。术后6个月和1年病人饮食量、体重分别恢复到术前的82.5%，98％和89％,98.5%。1，3，5年存活率分别为86.6%，60％和23％。结论 全胃切除P型空肠间置原位代胃术，符合解剖生理规律，并发症少，代胃效果较理想。     

全胃切除间置空肠重建消化道28例

我科自 1990年以来 ,选用间置空肠重建消化道 2 8例 ,现报告如下。临床资料1.年龄特征 :2 8例患者 ,男 18例 ,女 10例。最大年龄 76岁 ,最小年龄 2 1岁 ,平均年龄 48岁。2 .病理类型 :胃恶性淋巴瘤 8例 ,胃平滑肌肉瘤 6例 ,胃底腺癌 8例 ,胃体腺癌 6例。3 .手术方式 :全胃切除后 ,在屈氏韧带下 15～ 2 0ｃｍ处切断空肠 ,游离长约 2 0～ 2 5ｃｍ一段带血管蒂的空肠 ,通过横结肠左侧系膜无血管区的开孔拉到横结肠上方 ,将间置空肠的近端与食管对端吻合 ,间置空肠远端与十二指肠对端吻合 ,最后将切断的空肠远近端对端吻合 ,完成消化道的重建。…     

胃癌全胃切除功能性间置空肠代胃术42例报告

目的:探讨功能性间置空肠代胃术在全胃切除术中的应用及效果,以减少并发症,提高患者生活质量.方法:对42例胃癌患者应用功能性间置空肠代胃术,并进行定期随访.结果:施此术式患者未发生食管空肠吻合口瘘、食管炎及无胃综合征等并发症,患者术后存活率高,精神、营养状况良好,恢复部分体力活动.结论:功能性间置空肠代胃术是值得推荐的全胃切除的消化道重建术.     

胃癌全胃切除“P”型空肠间置代胃术24例分析

中国图书分类号】Ｒ７３５２Ｒ６５６６１我院自１９８８年１月～１９９６年１月对２４例胃癌病人施行根治性全胃切除，“ｐ”型近端空肠间置代胃术，效果较好，报告如下。陆林，男，３６岁，大学本科，主治医师，江苏油田医院外科，２２５２６１江苏省扬州市邵伯镇建...     

根治性全胃切除空肠间置代胃术疗效分析

目的探讨根治性全胃切除空肠间置代胃术对胃癌患者营养状况及生存质量的影响。方法对35例胃癌患者行根治性全胃切除空肠间置代胃术治疗,回顾性分析患者的临床资料。结果本组均顺利完成手术,术后生存期限均在1年以上。除3例患者术后出现轻度腹部疼痛外,其余均无出现食物反流、胸骨后烧灼、吞咽困难、胆汁反流症及吻合口炎症等并发症。与术前相比,所有患者术后平均体质量显著增加。血红蛋白、总蛋白、白蛋白水平显著提高并恢复至正常水平,差异有统计学意义(P0.05)。患者治疗后生存质量(QOL)评分及各维度得分较治疗前显著提高,差异有统计学意义(P0.05)。结论对胃癌患者行全胃切除手术后实施空肠间置手术重建消化道,可保留患者胃肠道生理功能,改善术后营养状况,提高术后生存质量。该手术操作简单、吻合口瘘发生率低,手术安全可靠,值得临床推广应用。     

全胃切除ρ型间置空肠代胃术26例

全胃切除作为胃癌根治术的常用术式,由于胃功能丧失,病人可出现不同程度的无胃综合征,如反流性食管炎、倾倒综合征、摄食不足、消化不良、体重下降、贫血等。严重影响了病人的生活质量。我院自1999年12月至2010年11月,采用ρ型间置空肠代胃对26例行全胃切除术的胃癌病人进行消化道重建,效果较好,现报告如下。     

连续性空肠间置在胃次全切除术消化道重建中的应用研究

目的 探讨胃次全切除术时采用连续性空肠间置完成消化道重建的临床效果。方法 远端胃癌患者34例，随机分成两组，A组16例，B组18例。胃次全切除后，A组行残胃与空肠、十二指肠与空肠的端侧吻合，再行空肠侧侧吻合，将胃空肠吻合的输入袢空肠和十二指肠空肠吻合口的输出袢空肠分别结扎阻断，形成完整的连续性间置空肠代胃。B组行Billroth Ⅱ式消化道重建。比较两组患者术后并发症发生率和死亡率；术后1年比较两组患者的Visiek分级指数、血浆白蛋白水平、每餐进食量和体重，并用胃镜检查残胃和吻合口情况。结果 两组患者术后均未出现并发症。术后1年观察，Visiek分级指数两组比较，u=2．1，P〈0．05；差异有统计学意义。A组所有患者平均每日进食量均在术前水平的85％以上，B组只有14人达到该水平。两组手术前后体重减少值比较，t=-2．181，P〈0．05；差异有统计学意义。两组手术前后血浆白蛋白变化值对比，差异有统计学意义（t=2．125，P〈0．05）；A组在1年后显著增加，与术前相比（t=-2．175，P〈0．05）差异有统计学意义。手术后1年胃镜复查，A组残胃未发现胆汁反流，吻合口通畅，吻合口黏膜和间置空肠无充血、水肿，而B组发现残胃内胆汁潴留11例（61．1％），吻合口炎症13例（72．2％），吻合口溃疡2例（11．1％）。结论 连续性空肠间置能够恢复消化道生理通道并避免反流性胃炎的发生。     

全胃切除空肠间置P式襻代胃术32例报告

胃癌的治疗是以手术为主的综合治疗，而手术治疗中全胃切除术在我国约占胃癌手术的6％。我院从1990年以来，施行全胃切除空肠间置P式襻代胃术共32例，收到满意的效果。现报告如下。     

间置空肠消化道重建术对全胃切除术后患者早期营养状况的影响

目的　评估间置空肠法 (JIP)是否是一种理想的全胃切除后消化道重建术。方法　将 94例在我院行择期全胃切除术者按随机双盲法分为两组 ,其中JIP组 4 2例 ,Roux en Y消化道重建术组 (RYP) 5 2例 ,对两组术后 1年内无肿瘤复发患者的营养状况的随访资料 (有无消化道症状、体重变化及其他营养指标 )进行对比分析。结果　两组患者术后营养状况明显优于术前 (P<0 .0 1) ,JIP组较RYP组改善更为明显 ,且无倾倒综合征 ,返流性食管炎发生率低 (P<0 .0 1)。结论　JIP术后肠道功能紊乱发生率低 ,且可明显改善患者术后早期营养状况 ,是全胃切除术后理想的消化道重建术式。     

全胃切除调节型双通道间置空肠消化道重建

目的介绍一种新的全胃切除消化道重建术。方法选取我院2004年6月至2006年3月期间行全胃切除病例38例。在行消化道重建时，对功能性空肠间置代胃（FJI）术作如下改良：将输出袢适度丝线结扎改为部分缩窄缝合2～3针，适当缩短输入袢肠管至20～25cm，Braun吻合口距Treitz韧带10cm，以食管空肠及Braun吻合口无张力为度。结果全组病例无围手术期死亡、吻合口漏及倾倒综合征发生。Roux-en—Y滞留综合征2例；返流性食管炎1例；Visick分级：35例Ⅰ级，3例Ⅱ级。血清营养学指标：仅2例血红蛋白低于正常。术后6个月，36例进食量和体重恢复术前水平，仅2例体重下降。造影钡剂主要进入十二指肠通道，少量通过部分缩窄通道。结论对FJI重建术的改良，不仅保留了原法的全部优点，而且可进一步降低并发症，改善患者生活质量，但需进行进一步的前瞻性对比研究。     

全胃切除术后的两种消化道重建方式

目的:探讨全胃切除术后较为合理的消化道重建术式。方法:对2001年6月—2008年6月所施行的全胃切除术采用保留幽门空肠间置术和食管空肠Orr式Roux-en-y吻合术两种消化道重建术式,对其术后12个月无肿瘤复发的96例患者进行营养状况(体重、消化道症状及营养指标)观察对比。结果:术后12个月随访,两组间营养状况无明显差异(P0.05﹚,保留幽门空肠间置重建组较空肠食管Roux-en-y吻合术组倾倒综合症和返流性食管炎发生率更低。结论:保留幽门空肠间置重建术可作为早、中期上半部胃癌全胃切除术后重建时的优先术式,食管空肠Roux-en-y吻合术可作为全胃切除术后不能行保留幽门空肠间置重建术的有效补充。     

Jejunal Pouch Interposition with Fundic-Like Plication After Total Gastrectomy

Purpose We developed a technique of jejunal pouch interposition with a fundic-like jejunal plication (JPI-FP) for reconstruction after total gastrectomy (TG) for gastric cancer. The aim of this study was to investigate the advantages of JPI-FP over Roux-en-Y reconstruction (R-Y).Methods Twenty-two patients who had undergone TG more than 1 year earlier were classified into two groups according to the method of reconstruction used: Group A (n = 7) underwent R-Y, and group B (n = 15) underwent JPI-FP. Group B was subdivided into two groups to examine the usefulness of additional pylorus preservation: group B1 (n = 8), pylorus (−) and group B2 (n = 7), pylorus (+).Results Food intake and body weight were significantly higher in group B than in group A (P < 0.05). Reflux esophagitis was diagnosed in two of the group A patients, but in none of the group B patients. Excessive esophageal bile exposure, determined as the fraction time of esophageal bilirubin absorbance over 0.14 > 50%, was significantly higher in group A than in group B (P < 0.05). There was no significant difference in bile exposure in the jejunal pouch between groups B1 and B2.Conclusions JPI-FP is a superior method of reconstruction after TG to prevent excessive esophageal bile reflux and from a nutritional aspect. The advantage of pylorus preservation remains unconfirmed.     

全胃切除术后不同代胃术式的评价

目的:探讨胃癌全胃切除术后合理的消化道重建方式。方法:对459例行全胃切除术并随访1年以上的胃癌(除外Ⅳ期)病人,以6种不同的方式进行消化道重建,分别为襻式吻合、改良BraunⅠ式、改良BraunⅡ式、Roux鄄en鄄Y式、“P”型空肠间置和功能性空肠间置代胃术式。对各组病人以术后并发症、体重、营养状况、预后营养指数(PNI)、血红蛋白水平、代胃半排空时间及Visick指数进行对照观察。结果:各组比较以功能性空肠间置组在防反流方面和血清白蛋白水平上明显优于其他组(P<0.01)。“P”型空肠间置与功能性空肠间置食糜流经十二指肠,其体重维持、各项营养参数(PNI)均高于不间置组(P<0.05)。结论:消化道重建保持食物流经十二指肠,又保护好代胃空肠神经,生理功能完整,是选择代胃方式的基本原则;功能性空肠间置是值得推荐的代胃术式。     

Medium- and Long-Term Results of Jejunal Pouch Reconstruction After a Total and Proximal Gastrectomy

Purpose We developed several kinds of jejunal (J)-pouch reconstruction after a gastrectomy for gastric cancer. The aim of this study was to investigate the advantages of these methods. Methods As for the treatment of malignant gastric diseases at stage II or earlier, we employed the J-pouch reconstruction (Roux-en-Y method: JPRY, or J-pouch interposing: JPI) following a total gastrectomy. We also used JPI after a proximal gastrectomy for early gastric cancer located in the upper third of the stomach. Results Out of a total of 80 patients, JPRY was performed in 40 patients and JPI in 40. No anastomotic leaks were associated with the use of an automatic stapler. The stapler (Endo GIA; U.S. Surgical, Norwalk, CT, USA) with a 60-mm-long white cartridge minimized bleeding from the anastomotic site and reduced the operative time. While two patients died of recurrence, all other patients are alive and well for a maximum of 15 years after surgery. The motility of the J pouch was satisfactory after both surgical procedures, as measured by the bile regurgitation test or the transit test employing radiopaque markers. The mean percentage of the radiopaque markers eliminated from the J pouch 1 h after breakfast was 7.5% in the JPRY group and 0%–33% in the JPI group. After another hour, the corresponding percentage was 19.5% in the JPRY group and 14%–60% in the JPI group. Conclusion Our procedures for J-pouch reconstruction are considered to result in a favorable postoperative quality of life and prognosis. J-pouch reconstruction is therefore advantageous in terms of operative morbidity, postoperative clinical signs, symptoms, and dietary status.     

全胃切除术后改良Orr式Roux-en-Y食管空肠吻合术的临床研究

目的探讨改良0rr式Roux-en-Y食管空肠吻合术的临床应用价值。方法胃癌行全胃切除术患者共38例,消化道重建按手术日期随机分为ρ型食管空肠吻合组（ρ型组）20例及改良Orr式Roux-en-Y食管空肠吻合组（改良组）18例。比较2组的手术时间、术中出血量、术后并发症发生率、贮袋排空时间和术前及术后3个月时的体重变化情况。结果改良组和ρ型组的手术时间分别为（229&#177;18）min和（283&#177;35）min（P〈0．05）;贮袋全排空时间分别为（35．7&#177;4．9）min和（3．0&#177;0．5）min（P〈0．01）。在术中出血量、术后并发症发生率和体重变化方面,2组间差异无统计学意义（P〉0.05）。结论改良Orr式Roux-en-Y食管空肠吻合术有利于操作,可节省手术时间,有一定贮袋功能,不增加并发症,有临床应用价值。     

Comparative Study on Three Types of Alimentary Reconstruction After Total Gastrectomy

Background  More than 70 alimentary reconstruction procedures after total gastrectomy have been proposed to reduce the postoperative syndromes such as dumping syndrome, reflux esophagitis, and malnutrition. However, the optimal alimentary reconstruction method is still a matter of debate. The aim of the current study was to investigate the rationality of different alimentary tract reconstruction methods after total gastrectomy for gastric malignancy. Methods  Three types of digestive reconstruction methods were performed after total gastrectomy in 285 cases of gastric malignancy from May 1996 to December 2006, including Orr-type Roux-en-Y reconstruction (Orr-type), P-type Roux-en-Y reconstruction (P-type), and Moynihan-type reconstruction (Moynihan-type) methods. The operative time, early postoperative complications and mortality, food intake, alimentary symptoms, Visick scores, nutritional status at 1 and 3years after surgery, and cumulative survival at 1, 3, and 5years were comparatively analyzed. Results  There were no significant differences among the three methods in early postoperative complications and mortality, postoperative food intake and nutritional status (hemoglobin, total proteins and albumin), and incidence of diarrhea and dumping syndrome at 1 and 3years (p > 0.05). The overall 1-, 3-, and 5-year cumulative survival rate were 75.30%, 39.86%, and 21.48%, respectively, without significant differences among the three groups (p > 0.05). However, the average operative time used in the Orr-type reconstruction method (2.9 ± 0.1h) was comparatively shorter than that used in the P-type (3.4 ± 0.2h) and the Moynihan-type (3.2 ± 0.1h). The incidences of reflux esophagitis after the gastric reconstruction with the Moynihan-type method at 1 and 3years (72% and 65%) were significantly higher than that with the Orr-type (3% and 0%) and P-type (5% and 0%; p < 0.01). Constituent ratio of Visick scores I–II of the Moynihan-type method at 1 and 3years (54% and 73%) were smaller than that of the Orr-type (94% and 96%) and the P-type (93% and 96%) methods (p < 0.01). Conclusion  Orr-type Roux-en-Y reconstruction method can avoid reflux esophagitis, and the procedure is simpler than the other two methods. Therefore, Orr-type Roux-en-Y reconstruction can be recommended as an adoptable method of digestive reconstruction after total gastrectomy for gastric cancer.     

Uncut Esophagojejunostomy with Double Jejunal Pouch: An Alternative Reconstruction Method that Improves the Quality of Life of Patients after Total Gastrectomy

Background: Currently, there is no optimal digestive tract reconstruction technique well recognized by scholars after total gastrectomy. In this study, a new reconstruction method, which is modified from the classic Roux-en-Y procedure, an uncut jejunal esophageal anastomosis with double jejunal pouch (UJEA-DJP) was established, and its advantages for improving the quality of life of patients who undergo total gastrectomy were analyzed. Methods: Altogether 160 patients with gastric cancer enrolled in our center from September 2009 to March 2012 received radical D2 total gastrectomy. According to the reconstruction methods used, these patients were divided into three groups: UJEA-DJP (n = 63), Roux-en-Y (n = 45), and P-loop with Roux-en-Y esophagojejunostomy (P-RY; n = 52). The operation time for reconstruction, complications, prognostic nutritional index (PNI), and the Visick classification among the three groups were analyzed. Results: We found that UJEA-DJP has advantages over Roux-en-Y and P-RY regarding the time of digestive tract reconstruction, incidence rates for long-term complications, postoperative nutritional index, body weight recovery, and the Visick classification for subjective feelings (p < .05). Conclusions: The UJEA-DJP surgical procedure has the advantages of intestinal continuity and double-pouch construction, which can significantly reduce long-term complications and improve the long-term quality of life of patients after surgical procedure.     

全胃切除消化道重建方式的探讨

目的　探讨全胃切除后消化道重建方式的合理选择。方法　回顾性分析 86例全胃切除患者的临床资料。 86例中 ,胃癌 76例 ,恶性淋巴瘤 8例 ,平滑肌肉瘤 2例。Ⅱ期 17例 ,Ⅲ期48例 ,Ⅳ期 2 1例。根治性全胃切除 48例 ,姑息性全胃切除 3 8例 ,联合脏器切除 2 8例。肝动脉置MT药泵 2 8例。消化道重建方式 :食管十二指肠吻合术 12例 ,食管空肠袢式吻合术 15例 ,食管空肠Roux Y吻合术 2 9例 ,间置空肠加袋术 3 0例。结果　术后并发症 18例 ,其中吻合口漏 3例 ,胰漏 1例。术后症状 :烧心 2 1例 ,倾倒综合征 18例 ,餐后上腹饱胀 15例 ,腹泻 12例 ,吞咽困难 9例。结论　全胃切除后 ,间置空肠加袋术在改善病人术后症状和生活质量方面是比较理想的重建术式。