Nomura Eiji, Shinohara Hisashi, Mabuchi Hideaki, Sang-Woong Lee, Sonoda Toyooki, Tanigawa Nobuhiko
Department of General and Gastroenterological Surgery, Osaka Medical College, Takatsuki, Japan.
Hepatogastroenterology. 2004 Sep-Oct;51(59):1561-6.
BACKGROUND/AIMS: To evaluate the efficacy of the jejunal pouch reconstruction following subtotal proximal and distal gastrectomy, a retrospective study examining the postoperative condition of patients who underwent different methods of reconstruction after gastrectomy for cancer was undertaken.
Various parameters indicative of postoperative function were evaluated at one year postoperatively, and two major groups were examined. The "proximal gastrectomy" group was composed of patients who underwent either 1) proximal gastrectomy with an interposed jejunal pouch (PG-pouch), 2) proximal gastrectomy with simple jejunal interposition (PG-inter), or 3) total gastrectomy with simple jejunal interposition (TG). The "distal gastrectomy" group was composed of patients who underwent either 4) distal gastrectomy with an interposed jejunal pouch (DG-pouch), 5) distal gastrectomy with simple jejunal interposition (DG-inter), or 6) distal gastrectomy with Billroth 1 reconstruction (B-1).
Volume of meal intake was better preserved and the incidence of abdominal symptoms were less frequent in the PG-pouch and DG-pouch groups. In the PG-inter, DG-inter and DG-pouch groups, none of the patients experienced heartburn or had endoscopic findings consistent with reflux esophagitis, while 2 patients (20.0%) in the PG-pouch group complained of heartburn with evidence of reflux esophagitis on endoscopy. Increase in blood acetaminophen level was milder in both the PG-pouch and DG-pouch groups, signifying improved gastric emptying.
The jejunal pouch interposition following proximal and distal gastrectomy seems to confer clinical benefit in terms of postoperative function, especially in the form of meal intake, abdominal symptoms, and gastric emptying. The side effect of an improved reservoir may be the incidence of reflux esophagitis seen in 2 patients in the PG-pouch group.
背景/目的：为评估近端和远端胃次全切除术后空肠袋重建的疗效，开展了一项回顾性研究，调查胃癌胃切除术后接受不同重建方法患者的术后情况。
术后一年评估各项反映术后功能的参数，并对两个主要组进行检查。“近端胃切除术”组由接受以下手术的患者组成：1）近端胃切除术加插入空肠袋（PG-袋）；2）近端胃切除术加单纯空肠插入（PG-插入）；3）全胃切除术加单纯空肠插入（TG）。“远端胃切除术”组由接受以下手术的患者组成：4）远端胃切除术加插入空肠袋（DG-袋）；5）远端胃切除术加单纯空肠插入（DG-插入）；6）远端胃切除术加毕罗一式重建（B-1）。
PG-袋组和DG-袋组的进食量保留得更好，腹部症状的发生率更低。在PG-插入、DG-插入和DG-袋组中，没有患者出现烧心或有与反流性食管炎相符的内镜检查结果，而PG-袋组有2名患者（20.0%）主诉烧心，内镜检查有反流性食管炎的证据。PG-袋组和DG-袋组对乙酰氨基酚血药浓度的升高都较轻微，表明胃排空有所改善。
近端和远端胃切除术后插入空肠袋似乎在术后功能方面带来临床益处，特别是在进食量、腹部症状和胃排空方面。PG-袋组2名患者出现反流性食管炎可能是这种改良储袋的副作用。
