中华胃肠外科杂志
中華胃腸外科雜誌
중화위장외과잡지
CHINESE JOURNAL OF GASTROINTESTINAL SURGERY
2011年
6期
411-414
,共4页
李防璇%张汝鹏%赵敬柱%王学军%薛强%梁寒
李防璇%張汝鵬%趙敬柱%王學軍%薛彊%樑寒
리방선%장여붕%조경주%왕학군%설강%량한
胃肿瘤,远端%胃切除术%消化道重建,非离断式Roux-en-Y吻合%反流性胃炎%Roux-en-Y潴留综合征
胃腫瘤,遠耑%胃切除術%消化道重建,非離斷式Roux-en-Y吻閤%反流性胃炎%Roux-en-Y潴留綜閤徵
위종류,원단%위절제술%소화도중건,비리단식Roux-en-Y문합%반류성위염%Roux-en-Y저류종합정
Stomach neoplasms,distal%Gastrectomy%Digestive tract reconstruction,uncut Roux-en-Y reconstraction%Reflex gastritis%Roux-en-Y stasis
目的 评价非离断式Roux-en-Y吻合用于远端胃癌根治术后消化道重建的临床效果.方法 回顾性分析2005年3月至2008年3月间天津医科大学肿瘤医院行远端胃癌根治术且有完整随访资料的419例患者,根据其不同的消化道重建方式分为:Uncut RY组(非离断式Roux-en-Y吻合)127例,B Ⅰ组(Billroth Ⅰ式)138例,M-BⅡ组(改良Billroth Ⅱ式)108例,RY组(Roux-en-Y吻合)46例.结果 Uncut RY组患者手术时间[(132.6±19.2)min]和术后住院时间[(10.4±1.2)d]较RY组[(142.5±11.7)min和(12.1±3.7)d]缩短(P<0.05);术后反流性胃炎发生率(3.2%,4/127)较B Ⅰ组(24.6%,34/138,P<0.05)和M-BⅡ组(25.9%,28/108,P<0.05)下降;吻合口溃疡发生率(0/127)较M-BⅡ组(4.6%,5/108,P<0.05)下降;Roux-en-Y潴留综合征(RSS)发生率(0/127)较RY组(17.4%,8/46,P<0.05)下降.结论 非离断式Roux-en-Y在保留传统Roux-en-Y术式减少碱性反流优点的同时,克服了RSS的弊病,是胃大部切除术后理想的消化道重建术式.
目的 評價非離斷式Roux-en-Y吻閤用于遠耑胃癌根治術後消化道重建的臨床效果.方法 迴顧性分析2005年3月至2008年3月間天津醫科大學腫瘤醫院行遠耑胃癌根治術且有完整隨訪資料的419例患者,根據其不同的消化道重建方式分為:Uncut RY組(非離斷式Roux-en-Y吻閤)127例,B Ⅰ組(Billroth Ⅰ式)138例,M-BⅡ組(改良Billroth Ⅱ式)108例,RY組(Roux-en-Y吻閤)46例.結果 Uncut RY組患者手術時間[(132.6±19.2)min]和術後住院時間[(10.4±1.2)d]較RY組[(142.5±11.7)min和(12.1±3.7)d]縮短(P<0.05);術後反流性胃炎髮生率(3.2%,4/127)較B Ⅰ組(24.6%,34/138,P<0.05)和M-BⅡ組(25.9%,28/108,P<0.05)下降;吻閤口潰瘍髮生率(0/127)較M-BⅡ組(4.6%,5/108,P<0.05)下降;Roux-en-Y潴留綜閤徵(RSS)髮生率(0/127)較RY組(17.4%,8/46,P<0.05)下降.結論 非離斷式Roux-en-Y在保留傳統Roux-en-Y術式減少堿性反流優點的同時,剋服瞭RSS的弊病,是胃大部切除術後理想的消化道重建術式.
목적 평개비리단식Roux-en-Y문합용우원단위암근치술후소화도중건적림상효과.방법 회고성분석2005년3월지2008년3월간천진의과대학종류의원행원단위암근치술차유완정수방자료적419례환자,근거기불동적소화도중건방식분위:Uncut RY조(비리단식Roux-en-Y문합)127례,B Ⅰ조(Billroth Ⅰ식)138례,M-BⅡ조(개량Billroth Ⅱ식)108례,RY조(Roux-en-Y문합)46례.결과 Uncut RY조환자수술시간[(132.6±19.2)min]화술후주원시간[(10.4±1.2)d]교RY조[(142.5±11.7)min화(12.1±3.7)d]축단(P<0.05);술후반류성위염발생솔(3.2%,4/127)교B Ⅰ조(24.6%,34/138,P<0.05)화M-BⅡ조(25.9%,28/108,P<0.05)하강;문합구궤양발생솔(0/127)교M-BⅡ조(4.6%,5/108,P<0.05)하강;Roux-en-Y저류종합정(RSS)발생솔(0/127)교RY조(17.4%,8/46,P<0.05)하강.결론 비리단식Roux-en-Y재보류전통Roux-en-Y술식감소감성반류우점적동시,극복료RSS적폐병,시위대부절제술후이상적소화도중건술식.
Objective To evaluate the clinical efficacy of uncut Roux-en-Y reconstruction after distal gastrectomy for gastric cancer. Methods Clinical data of 419 patients who underwent distal gastrectomy for gastric cancer with complete follow-up data between March 2005 and March 2008 in the Cancer Institute and Hospital of Tianjin Medical University. Patients were divided into B I (138 cases with Billroth I reconstruction), M-B II (108 cases with modified Billroth II reconstruction), RY(46 cases with Roux-en-Y reconstruction) and Uncut RY(127 cases with uncut Roux-en-Y reconstruction) according to reconstructive methods. Results Patients in the Uncut RY group had a larger tumor diameter, more T3, and poorer stage of disease compared to those in the B I (P<0.05). In Uncut RY group, the operative time and postoperative hospital stay were (132.6±9.2) minutes and (10.4±1.2) days respectively,shorter than those in RY group (142.5±1.7) minutes and (12.1±3.7) days (both P<0.05), alkaline reflex gastritis rate was 3.2%, lower than that in B I group (24.6%, P<0.05) and M-B II group (25.9%,P<0.05). Marginal ulcer rate in uncut RY group was lower compared to M-B II group (P=0.019), and incidence of Roux-en-Y stasis syndrome was less compared to RY group (P=0.000). Conclusions The uncut Roux-en-Y reconstruction is both feasible and safe. It can prevent alkaline reflex gastritis and Roux-en-Y stasis syndrome. It may be the preferred technique for reconstruction after distal gastrectomy.
