非离断式Roux—en—Y吻合在腹腔镜全胃切除术消化道重建中的应用

目的：探讨非离断式Roux—en—Y吻合术匝用于腹腔镜全胃切除术消化道重建中的临床效果。方法：将102例胃癌患者按全胃切除后消化道重建方式不同分为非离断式Roux—en—Y吻合术（A组，30例）和Orr式空肠食管Roux—en—Y吻合术（B组，72例）。比较2组患者消化道重建的时间、术后并发症发生情况、进食后症状、单餐进食量、体质量和相关营养代谢指标。结果：消化道重建时间A组（38．1±3．1）mlnjB组（44．7±2．9）min，差异有统计学意义（P〈0．05）。反流性食管炎及倾倒综合征发生率2组差异无统计学意义（P〉0.05）；Roux—en—Y滞留综合征（RSS）发生率A组3．3％，明显低于B组（22．2％，P〈0．05）。术后12个月Visick分级指数I～Ⅱ级者A组优于B组（P-0．034）。术后6个月，除血红蛋白外，体质量、白蛋白下降程度及预后营养指数（PNI）A组优于B组，差异有统计学意义（P〈0．05）。术后12个月，相关营养代谢指标2组差异无统计学意义（P〉0．05）。结论：非离断式Roux—en—Y术发挥了保持肠道连续性和手术相对简单的优势，减少术后RSS并发症，改善患者营养状况，是临床上值得推广的一种消化道重建方式。

Application of uncut Roux-en-Y esopbagojejunostomy in the digestive tract reconstruction after laperoscopy total gastrectomy

Objective： To investigate the efficacy of uncut Roux-en-Y esopbagoje-junostomy in the digestive tract reconstruction after Laperoscopy total gastrectomy,Methods： 102 cases re- spectively receiving the uncutted Roux-en-Y esophagojejunostomy（group A, n=30） and Roux-en-Y esophagojejunostomy with the Orr-type jejunal pouch（group B, n=72） were retrospectively studied. The digestive tract reconstruction time, the post-operative morbidity, postprandial, intake quantity, weight loss and serum nutritional parameters were respectively compared. Results： It took short- est minutes to finish the reconstruction in group A （38.1 ＋3.1）min, which was shorter than that in group B（44.7 ＋ 2.9）min. There were no significant differences among two groups in the incidence of dumping syndrome and reflux esophagitis. Group A（3.3%） was significantly lower than group B （22.2%） in the incidence of roux stasis syndrome. The Visick point I-II postoperative 12 months in group A was superior to group B. After 6 months, weight, ALB loss and prognosis nutritional index （PNI） in group A was lower to those in group B. There were no significant differences among two groups in the term of weight, Hb and ALB toss and PNI after 12 months. Conclusion： The uncutted Roux-en-Y esophagojejunostomy surgery is worthy of promoting a way of digestive reconstruction after Laperoscopy total gastrectomy, which can give full play to maintain advantages of intestinal continuity and simple operation, prevent roux stasis syndrome, improve better nutritional status and quality of life.