全胃切除消化道重建方式对术后营养恢复的影响

目的 探讨胃恶性肿瘤全胃切除后“P”型Roux-en-Y空肠代胃对术后营养恢复的影响。方法对经病理证实为胃癌并行全胃切除术的患者进行术后随访，随访期为半年。获访病例数64例，根据其手术方式分为Roux-en-Y和“P”型Roux-en-Y空肠代胃两组，观察总结患者术后并发症、进食量和体质量变化的情况。结果获得病例数64例，Roux-en-Y术式24例，“P”型Roux-en-Y空肠代胃术40例。两组在术后进食量上差异有显著性意义(P&;lt;0，05)。结论 全胃切除术后消化道重建时，“P”型Roux-en-Y空肠代胃术是一种较好的消化道重建手式．     

全胃切除空肠P袢代胃术治疗胃底贲门癌的临床疗效研究

目的探讨研究全胃切除空肠P袢代胃术治疗胃底贲门癌的临床疗效研究。方法将符合标准的65例胃底贲门癌患者,随机分成观察组33例与对照组32例,观察组患者使用全胃切除空肠P袢代胃术进行治疗,对照组患者采用常规近侧胃切除术进行治疗。比较观察组与对照组的疗效、生存率与不良反应发生情况。结果两组患者在手术时间、术中出血量、切口愈合时间以及住院时间上没有统计学差异(P>0.05)。观察组患者3个月、6个月与12个月的胃排空时间与每次饮食量均显著高于对照组(P<0.05);观察组患者3个月与6个月每日饮食次数显著低于对照组(P<0.05)。观察组患者3年生存率为66.7%,显著高于对照组的40.6%(P<0.05)。观察组患者胃排空障碍发生率与不良反应总发生率分别为0.0%与9.1%,均显著低于对照组的15.6%与31.3%(P<0.05)。结论全胃切除空肠P袢代胃术治疗胃底贲门癌能够有效地提高患者的生存率与生活质量,减少不良反应的发生,具有较好的临床意义,值得在临床上推广使用。     

袢式空肠代胃改良术在胃癌全胃切除术后消化道重建术中的应用

目的 探讨袢式空肠代胃改良术在胃癌全胃切除术后消化道重建术中的应用.方法 对16例行全胃切除术的胃癌患者均行袢式空肠代胃改良术,术中将袢式空肠分别做2个Braun's侧侧吻合,在2个侧侧吻合口上1/3处用7#线结扎.结果 16例患者术后均进行了随访,随访时间6个月～3年,3例死于术后复发和转移.13例存活,无一例出现饱胀、胃排空、反流性食管炎和倾倒综合征等并发症;术后体质量及钾、钠、氯、钙均较术前明显改善;术后经钡餐检查,口服钡剂经过30、60、120 min后分别有40%、60%、90%由代胃肠袢排出.Visick分级指数为Ⅰ级6例,Ⅱ级10例.结论 全胃切除术的胃癌患者行袢式空肠代胃改良术,其食物储存量和排空时间较为满意.保证了重建消化道神经-肌肉功能的连续性,减少了并发症,提高了患者的生存质量,是一种比较合理的术式.     

全胃切除两种代胃术式的临床比较

目的：探讨更加符合生理学要求的全胃切除消化道重建术式。方法：将33例行消化道重建的胃近侧部癌患者分为两组。A组（n=16）行“P”袢＋Roux-en-y间置代胃术；B组（n=17）行空肠原位间置代胃术。术后随访12个月，比较两组患者的血红蛋白、血浆蛋白及体重变化；了解“代胃”排空及反流情况。结果：两组血浆蛋白与体重下降数值比较，差异有统计学意义（P〈0．05，P〈0．01），B组的血液营养学指标及体重增长指标优于A组。“代胃”排空时间A组平均25min，B组平均30min两组均无胆汁反流及倾倒综合征。结论：食管空肠原位间置代胃术是胃近侧部癌全胃切除术后消化道重建的一种较合理术式。     

管型吻合器在经腹全胃切除P型空肠袢代胃术中的应用

目的：探讨管型吻合器在经腹全胃切除P型空肠袢代胃术中的应用。方法：对126例经腹全胃切除P型空肠袢代胃术患者术中采用管型吻合器行食管-空肠、空肠-空肠（P型袢）及空肠-空肠（Roux-Y）吻合口吻合。结果：所有患者手术均获成功，手术时间2～2．5h，平均3．5h，其中3个吻合口吻合完成时间25～50min，平均40min；无手术死亡病例，无吻合口瘘、出血及狭窄等严重并发症。结论：经腹全胃切除P形空肠袢代胃术中采用管型吻合器行3个吻合口吻合具有操作简便、技术可靠及并发症少等优点。     

改良食管空肠B型吻合术治疗全胃切除98例分析

作于1990年3月至2004年4月对98例胃癌患实施全胃切除后采用改良食管空肠B型吻合反P型空肠代胃术，取得了满意的临床效果，现总结报告如下。     

经腹全胃切除46例体会

近十年来，我院行全胃切除46例，手术方法基本上为三种：Orr式空肠食管Roux-en-Y吻合术和袢式空肠食管Roux-en-Y吻合术(PR)以及原位十二指肠、部分空肠翻转代胃术(以下简称为部分空肠翻转代胃术)。现将其治疗情况作一比较分析。     

全胃切除Roux-y式P型空肠袢代胃术28例

全胃切除术在胃癌外科中占很重要的地位 ,对于消化道重建问题 ,目前尚无公认的理想术式。我院自 2 0 0 0～ 2 0 0 2年为 2 8例胃癌行全胃切除 ,采用Roux y式p型空肠袢代胃术进行消化道重建 ,应用国产弯管型吻合器完全代替手法吻合 ,并制成抗反流瓣 ,近期疗效较满意 ,现报告如下。1　临床资料1 1　本组 2 8例中男 18例 ,女 10例。年龄 4 2～ 6 8岁 ,平均 5 6 2岁。全组病例均经胃钡餐造影和纤维胃镜确诊为胃癌。癌灶位于胃底贲门部 6例 ,胃体部 18例 ,胃体窦部 3例 ,皮革样胃 1例。病理类型 :腺癌 2 5例 ,未分化癌 2例 ,胃肉瘤 1例。本组病…     

我院胃手术后病人的饮食护理

胃的手术包括全胃切除术、胃大部切除术、胃部分切除术、胃空肠吻合术等，胃肠吻合又分毕氏Ⅰ式和毕氏Ⅱ式，全胃切除后则多为食管空肠吻合即空肠袢代胃术。在临床工作中，胃手术后往往因进饮进食不合理或饮食不节引起呕吐、上腹部憋胀、倾倒综合征、吻合口出血、吻合口瘘等并发症，给病人带来了不应有痛苦。为了减少胃手术后并发症的发生，使病人顺利度过术后恢复期，促进病人康复，正确合理的饮食护理在整个治疗和康复过程中起着非常重要的作用。现就胃手术后，针对不同术式，怎样做好饮食护理等问题介绍如下。     

改良袢式代胃术在胃癌姑息性全胃切除术中的应用（附21例临床分析）

全胃切除是治疗胃恶性肿瘤最主要的方法之一.有时为了解决胃癌病人的梗阻、出血症状,改善病人的生存质量,不得不采取姑息性全胃切除手术.但如何降低这些病人的手术死亡率和并发症,一直是外科医师不断探索的问题.作者从 1998年 1月～ 2002年 1月行胃癌姑息性全胃切除,改良袢式代胃术 21例,临床效果满意,现报告如下.     

全胃切除术后两种常用消化道重建方式的比较

目的探讨全胃切除术合理的消化道重建方式。方法回顾分析我院1999—2008年所开展全胃切除手术病例,选择其中最常采用的P袢空肠Roux—en—Y重建术和功能性空肠间置吻合术,对其手术难度、术后病人的并发症及营养差异进行比较。结果两种手术方法手术难度、术后并发症相差不太。P袢空肠Roux—en—Y重建术后早期适应性较好;功能性空肠间置吻合术后病人后期营养优于前者。结论全胃切除后,P袢Roux—en—Y吻合术和功能性空肠间置吻合术在改善患者术后症状和生活质量等方面是比较理想的重建术式,但功能性空肠间置吻合术是一种更符合生理,更能解决全胃切除后病人发生营养障碍的术式。     

Robot-assisted total remnant gastrectomy for interposed jejunal pouch dysfunction 25 years after proximal gastrectomy for gastric cancer: A case report

Proximal gastrectomy (PG) in combination with jejunal pouch interposition is a technique aimed at improving the postoperative dietary outcomes; however, some cases are reported to require surgical intervention owing to difficulty of food intake caused by pouch dysfunction. Herein, we present a case of robot-assisted surgery for interposed jejunal pouch (IJP) dysfunction in a 79-year-old male, occurring 25 years after the initial PG for gastric cancer. The patient had chronic anorexia for 2 years and was treated with medications and dietary guidance; however, 3 months prior to admission his quality of life had reduced, owing to worsening symptoms. The patient was diagnosed with pouch dysfunction due to extremely dilated IJP identified using computed tomography and underwent robot-assisted total remnant gastrectomy (RATRG) with IJP resection. After an uneventful course of intraoperative and postoperative treatment, he was discharged with sufficient food intake on postoperative day 9. RATRG can, thus, be considered in patients with IJP dysfunction after PG.     

D2 gastrectomy -- a safe operation in experienced hands

In the contemporary practice, surgery is the only potentially curative treatment available for gastric cancer. However, there is no consensus on the extent of surgical resection. Advantages of D2 gastrectomy in terms of morbidity, mortality, local recurrence and survival are confirmed in Japanese as well as some European trials. In our hospital, all patients with operable gastric cancer are treated with D2 gastrectomy along with splenectomy and distal pancreatectomy followed by jejunal pouch reconstruction. The study was undertaken to evaluate our practice in terms of postoperative morbidity and mortality. All the patients who had total gastrectomy for gastric carcinoma from January 1995 to December 2000 were included in the study. During this 6-year period, 33 patients underwent potentially curative D2 gastrectomy. Postoperative morbidity and mortality were 18 and 9%, respectively. There were no anastomotic leaks. Three (9%) patients developed dysphasia, of which two (6%) had anastomotic stricture requiring dilatation. We feel D2 gastrectomy with splenectomy and distal pancreatectomy when performed electively is a safe procedure in experienced hands. Oesophago-jejunal anastomosis can be safely performed using circular stapler.     

Proximal gastrectomy and jejunal pouch interposition: radiographic evaluation of postoperative findings

BACKGROUND: We assessed the postoperative findings of proximal gastrectomy and jejunal pouch interposition with contrast radiography. METHODS: Eleven patients with proximal gastrectomy and jejunal pouch interposition for proximal gastric carcinoma underwent contrast radiography. We evaluated the radiographic findings of the remnant stomach and interposed jejunal pouch. RESULTS: The interposed jejunal pouch showed good expansion, and the motility of the remnant gastric antrum was normal in all patients. One patient had significant lumenal narrowing of the esophageal pouch anastomotic site. Leak at the anastomotic site was not found. Reflux into the esophagus from the pouch was observed in two patients. Gastric emptying time was considerably delayed in two patients. CONCLUSION: Follow-up upper gastrointestinal series of the proximal gastrectomy and jejunal pouch interposition showed different postoperative findings. Awareness of the normal and abnormal findings is essential in the accurate postoperative evaluation of these patients.     

Results of the surgical therapy of stomach cancer

1589 patients treated between 1965 and 1985 at the First Surgical Department of Vienna University were investigated to answer the following questions: 1. Development of postoperative mortality. 2. Is a palliative gastrectomy indicated? 3. Does gastrectomy en principe improve survival? 4. Quality of life after total gastrectomy. Postoperative mortality after distal resection was decreased from 8% to 1.2%. After total gastrectomy mortality was reduced from 20% to 4.3%. A significant factor in this improvement was the use of Y-Roux reconstruction as the only method during recent years. After palliative resections the mortality was not higher than in curative operations. Comparison of comparable tumour stages of the mid stomach revealed no benefit of gastrectomy over distal resection in terms of survival. This was found to apply to both cases of negative and positive lymph node involvement as well. Gastrectomy en principe does not seem to improve survival rates. The quality of life after total gastrectomy (Y-Roux) is satisfactory in most patients. Dumping and reflux were rare, diarrhoea occurred in 22%, anaemia in 30% of patients.     

Circular staplers in esophagojejunal and esophagogastric anastomoses

A report on 100 consecutive esophagoenteric anastomoses (EEA stapler) following total (esophagojejunostomy) or proximal gastrectomy (esophagogastrostomy) is presented. The following intraoperative problems occurred: insufficiency of the purse string suture [4], lumen of the esophagus too small [1], rupture of the esophageal wall [4], incomplete rings [4]. Fatal postoperative complications included two cases of insufficiency of the esophagojejunostomy, whilst the remaining six postoperative deaths were not linked to the use of the stapler (operative mortality 8%). Follow-up showed no recurrence at the stapler line, but two anastomotic strictures occurred. The EEA stapler is a helpful instrument to reduce leakage at the esophagoenteric anastomosis and, hence operative mortality after total and proximal gastrectomy.     

改良下鼻甲成形术治疗慢性肥厚性鼻炎的临床研究

目的探讨改良下鼻甲成形术治疗慢性肥厚性鼻炎患者的临床疗效及手术技巧。方法 76例不伴有显著黏膜肥厚的慢性肥厚性鼻炎患者随机分组,38例行鼻内镜改良下鼻甲成形术(A组),38例行下鼻甲骨折外移术(B组),比较两组治疗下鼻甲肥大的疗效。结果两组组内术前与术后比较,鼻阻力值及VAS评分均显著降低(P<0.05);两组间术前与术后1个月时鼻阻力及VAS评分比较差异无统计学意义(P>0.05),而术后1年时差异有统计学意义(P<0.05);A组组内比较术后近、远期疗效差异无统计学意义(P>0.05),B组组内比较术后近、远期疗效差异有统计学意义(P<0.05)。结论改良下鼻甲成形术是改善不伴有显著黏膜肥厚的慢性肥厚性鼻炎患者鼻塞的有效方法,近、远期疗效都比较理想,值得临床推广。     

The Present Status of the Treatment of Gastric Malignancy

Successful treatment of gastric cancer is related to early recognition of these tumors and dependent on more thorough surgical removal of all cancer tissue. In many cases this will mean a total gastrectomy. Radical surgery is indicated when more thorough removal of all cancer tissue is thus insured and when such extensive operations can be done without increased morbidity or increased mortality. Operative mortality with total gastrectomy is approximately that of partial gastrectomy. If our five year survival rate can be increased and the operative mortality not be increased, a more extensive operative procedure such as total gastrectomy is justified.     

腹腔镜胃癌根治术819例术后早期并发症的分析及防治

目的分析腹腔镜胃癌根治术并发症的发生情况,探讨提高手术安全性的方法。方法总结我院2010年1月1日至2013年12月31日819例腹腔镜胃癌根治术患者术后早期1个月内的临床资料,分析并发症发生情况。结果 819例腹腔镜胃癌根治术患者共发生术后早期并发症73例,发生率8.9%,死亡3例,死亡率0.4%。术前合并症、手术者经验、手术时间和淋巴结转移情况与腹腔镜胃癌根治术术后并发症的发生相关。结论腹腔镜胃癌根治术具有较高的安全性,严格掌握手术适应证,术中规范操作,术后细致管理,可有效预防腹腔镜胃癌根治术并发症的发生。