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1、中國普外基礎(chǔ)與臨床雜志2008年1月第15卷第1期ChinJBasesClinGeneralSurg,Vol.15,No.1,Jan.2008·23·【文章編號】1007-9424(2008)01-0023-04胃癌·臨床研究全胃切除調(diào)節(jié)型雙通道間置空腸消化道重建333333肖仕明姜淮蕪陳進肖平郭海燕孫燕【摘要】目的介紹一種新的全胃切除消化道重建術(shù)。方法選取我院2004年6月至2006年3月期間行全胃切除病例38例。在行消化道重建時,對功能性空腸間置代胃(FJI)術(shù)作如下改良:將輸出袢適度絲線結(jié)扎改為部分縮窄縫合2～3針,適當(dāng)縮短輸入袢腸管至20～25cm,Braun吻合
2、口距Treitz韌帶10cm,以食管空腸及Braun吻合口無張力為度。結(jié)果全組病例無圍手術(shù)期死亡、吻合口漏及傾倒綜合征發(fā)生。Roux2en2Y滯留綜合征2例;返流性食管炎1例;Visick分級:35例Ⅰ級,3例Ⅱ級。血清營養(yǎng)學(xué)指標(biāo):僅2例血紅蛋白低于正常。術(shù)后6個月,36例進食量和體重恢復(fù)術(shù)前水平,僅2例體重下降。造影鋇劑主要進入十二指腸通道,少量通過部分縮窄通道。結(jié)論對FJI重建術(shù)的改良,不僅保留了原法的全部優(yōu)點,而且可進一步降低并發(fā)癥,改善患者生活質(zhì)量,但需進行進一步的前瞻性對比研究。【關(guān)鍵詞】功能性空腸間置代胃術(shù)改良全胃切除消化道重建【中圖分類號】R656.61∶R
3、735.2【文獻標(biāo)識碼】ANewDoubleTractDigestiveReconstructionofTotalGastrectomy:TheModifiedFunctionalJejunalInterposition3333333XIAOShi2ming,JIANGHuai2wu,CHENJin,XIAOPing,GUOHai2yan,SUNYan.TheSecondDepartmentofGeneralSurgery,TheSecondAffiliatedHospitalofNorthernSichuanMedicalCollege,Mianyang621000,C
4、hinaCorrespondingAuthor:JIANGHuai2wu,E2mail:Jhuaiwu@yahoo.com.cn【Abstract】ObjectiveTodescribeanewtechniquefordigestivetractreconstructionoftotalgastrectomy.MethodsThemodifiedfunctionaljejunalinterposition(FJI)wasperformedin38patientswhounderwenttotalgas2trectomybetweenJune2004andMarch2006
5、.Atdigestivetractreconstruction,thejejunumwithsuitablesutureli2gatedat2cmdistaltoside2to2endjejunoduodenostomywaschangedtosewup2-3needlesandtonarrowit.End2to2sideesophagojejunostomytoTreitzligamentwasshortenedto20-25cmbefittingly.Side2to2sidejejunojejunosto2mytoTreitzligamentwas10cm.Bothe
6、sophagojejunostomyandjejunojejunostomymustnotbetensioned.ResultsNopatientsdiedorhadanastomoticleakageinperioperativeperiod.Roux2en2Ystasissyndrome(RSS)wasin2patients.TheVisickgrade:35patientsweregradeⅠ,3patientsweregradeⅡ.Serumnutritionalparametersin2patientshemoglobinwasonlylowerthannorm
7、al.At6monthsafteroperation,foodintakepermealandbodyweightwererecoveredtothepreoperativelevelin36patients,andonly2patientsappearedweightworse.Onepatienthadrefluxesophagitisandnodumpingsyndromeoccurred.Throughtheuppergastrointestinalradiograph,thebariumsenteredintoduo
