Parneix M, Lotte P
Int Surg. 1975 Oct;60(10):521-3.
Gastroduodenal anastomosis is not routine during reoperation for stomal ulcers after primary Billroth II gastrectomy. It nevertheless is a sure way to prevent an increased peptic potential which is brought about by a duodenal bypass. We have reviewed the published cases and added three more, bringing the total to 47. We analyzed the modalities, indications and results of this method. Gastroduodenal anastomosis can be accomplished more often than is thought, despite the often necessary large gastric resections. Separation of the duodenopancreatic block and liberation of the fundus allows suturing without traction. End-to-side anastomosis of the stomach on the anterior wall of the second portion of the duodenum avoids dissection of the duodenal stump. Vagotomy is required when basal acidity is greater than 20 mEq/liter. Reestablishing a physiologic alimentary tract is particularly indicated in chronic obstruction due to stenosis associated with a proximal loop syndrome in young patients. Jejunal interposition becomes necessary when total gastrectomy is the result of repeated surgery. Such a method is the best solution for agastria. The excellent results obtained by gastroduodenal anastomosis after repeat gastrectomy should encourage wider use.
在初次毕罗Ⅱ式胃切除术后因吻合口溃疡再次手术时，胃十二指肠吻合术并非常规操作。然而，这是预防十二指肠旁路导致的消化性潜能增加的可靠方法。我们回顾了已发表的病例并新增了3例，使总数达到47例。我们分析了该方法的方式、适应证及结果。尽管常常需要进行较大范围的胃切除，但胃十二指肠吻合术的完成频率比想象的要高。分离十二指肠胰腺块并游离胃底可在无牵拉的情况下进行缝合。在十二指肠第二部前壁行胃端侧吻合可避免十二指肠残端的解剖。当基础酸度大于20毫当量/升时需要进行迷走神经切断术。对于年轻患者因近端肠袢综合征相关狭窄导致的慢性梗阻，尤其需要重建生理性消化道。当再次手术导致全胃切除时，空肠间置术就成为必要。这种方法是治疗无胃症的最佳解决方案。再次胃切除术后胃十二指肠吻合术所取得的良好效果应促使其更广泛地应用。
