胃切除术后新型空肠间置方法

New type of jejunal interposition method after gastrectomy.

作者信息

Zherlov Georgy, Koshel Andrey, Orlova Yuliya, Zykov Dmitry, Sokolov Sergey, Rudaya Nataliya, Karpovitch Alexander

机构信息

Department of Surgery, Scientific Research Institute of Gastroenterology, Seversk, Tomsk Region, Russia.

出版信息

World J Surg. 2006 Aug;30(8):1475-80. doi: 10.1007/s00268-005-7980-0.

DOI:10.1007/s00268-005-7980-0

PMID:16850144

Abstract

BACKGROUND

Total and subtotal gastrectomies are methods of choice in surgical treatment of gastric cancer. These ablative operations eliminate the gastric reservoir and severely alter digestive physiology.

METHODS

We have created a unique method of reconstruction of "the jejunal pouch" following gastrectomy using the first loop of the jejunum together with the formation of antireflux anastomosis.

RESULTS

An analysis of the results of the application of a new way of reconstruction of the digestive path was carried out. Seventy-five patients with gastric cancer received the new type of reconstruction. Among them, there were 52 men and 23 women aged 36-72 years. In the new interposition method group, in the first year after the surgical operation, the patients returned to 89.8% of their original body weight and in the second year to 89.7%; and in the Roux-en-Y group the patients returned to 64.4% and 59.2% of their body weight respectively. Further body weight fluctuations in patients after the new operative technique were determined by diet and aging and were not connected with digestive disorders. In the group receiving the new operative technique, the dumping syndrome was recorded in 4 (5.3%) patients and in the Roux-en-Y operation this syndrome occurred in 22 (27.5%) patients more than 1 year following the operations. There were no cases of reflux disease in the group undergoing the new operative technique. The average evacuation time of the "jejunal pouch" was 84+/-9.8 min after the new operation and 57.5+/-10.1 minutes after the Roux-en-Y operation.

CONCLUSIONS

The comparative analysis of the results of the new operation (75 patients) with 80 patients (who were operated on using the traditional method) after the Roux-en-Y operation showed the significant advantages of the new method due to a diminished occurrence of troublesome gastrointestinal symptoms. We consider that the reconstruction of the gastrointestinal tract after total gastrectomy should give the maximal comfort for the rest of the patient's life.

摘要

背景

全胃切除术和胃次全切除术是胃癌外科治疗的首选方法。这些切除手术消除了胃储存器并严重改变了消化生理。

方法

我们创建了一种独特的胃切除术后“空肠袋”重建方法，使用空肠的第一袢并形成抗反流吻合术。

结果

对一种新的消化道重建方法的应用结果进行了分析。75例胃癌患者接受了新型重建手术。其中，男性52例，女性23例，年龄36 - 72岁。在新的间置法组中，手术后第一年患者体重恢复到原来的89.8%，第二年恢复到89.7%；而在Roux-en-Y组中，患者体重分别恢复到原来的64.4%和59.2%。新手术技术患者术后的进一步体重波动由饮食和衰老决定，与消化紊乱无关。在接受新手术技术的组中，4例（5.3%）患者出现倾倒综合征，而在Roux-en-Y手术组中，22例（27.5%）患者在手术后1年以上出现该综合征。接受新手术技术的组中没有反流性疾病病例。新手术后“空肠袋”的平均排空时间为84±9.8分钟，Roux-en-Y手术后为57.5±10.1分钟。