Borrelli Domenico, Borrelli Andrea, Presenti Luigi, Bergamini Carlo, Basili Giancarlo
Chirurgia Generale e Vascolare, Azienda Ospedaliera Careggi, Firenze.
Ann Ital Chir. 2007 Jan-Feb;78(1):3-10.
Post-gastrectomy syndromes (PGS) are iatrogenic conditions which may arise from partial gastrectomies, independently from their indications (cancer or ulcer) and the reconstruction technique (Billroth I, Billroth II or Roux-en-Y). They are usually less frequent in patients with a Roux-en-Y reconstruction, but also this technique does not surely prevent SPG. Recently, some new technique have been proposed in order to prevent the PGS. Most of them are based upon a less extensive resection of the viscus, replaced by application of simple stapler mediated interruptions (the so called "uncut" technique). We aimed to verify whether such less invasive technique were also able to exert a therapeutic role for various type of PGS with the same efficiency of the traditional ri-resection techniques, which are known to generally have a major morbidity impact.
Nineteen patients, 12 male and 7 female, aged between 44 and 67 years, have been operated since 1985 up to 2004. All of them had an overt SPG (2 with efferent loop syndrome, 10 with gastro-esophageal biliary reflux, 3 with an afferent loop disease and, finally, 4 with a late dumping disease. The series has been divided into two groups depending on the type of surgical technique we chose for the correction of their SPG: "high surgery" patients (HS), operated with Roux re-resection and TADE, "low surgery" (LS) patients treated with "uncut" techniques and or Braun/GEA anastomosis. Both group were comparatively analyzed for the surgical outcome using an Eckhauser and a Visick scale.
Out of the 11 patients of the first group 8 had a Roux ri-resection and 3 a TADE, whereas subjects from the second group underwent in four cases to a Braun/uncut afferent loop closer, which was associated to a GEA in the remnant ones. In both group there was no mortality rate, whereas only one subjects from the HS group had a post-operative complication. Either the Visick and the Eckauser score was better in the LS group.
Data collected show that SPG, even if represented an heterogeneous group of clinical conditions, can be generally treated following a surgical procedure as conservative as possible. Such conclusion may open further views in the laparoscopic management of SPG.
胃切除术后综合征（PGS）是一种医源性病症，可由部分胃切除术引发，与手术指征（癌症或溃疡）及重建技术（毕罗Ⅰ式、毕罗Ⅱ式或 Roux-en-Y 式）无关。在接受 Roux-en-Y 重建的患者中，PGS 通常较少见，但该技术也不能确保预防胃切除术后综合征（SPG）。最近，为预防 PGS 提出了一些新技术。其中大多数基于对脏器进行范围较小的切除，代之以使用简单吻合器进行间断缝合（即所谓的“不切断”技术）。我们旨在验证这种侵入性较小的技术对于各种类型的 PGS 是否也能发挥治疗作用，其效率是否与传统的再次切除术相同，而传统再次切除术通常具有较高的发病率影响。
自 1985 年至 2004 年，对 19 例患者进行了手术，其中男性 12 例，女性 7 例，年龄在 44 至 67 岁之间。所有患者均患有明显的 SPG（2 例为输出袢综合征，10 例为胃食管胆汁反流，3 例为输入袢疾病，最后 4 例为晚期倾倒综合征）。根据我们为纠正其 SPG 所选择的手术技术类型，该系列患者分为两组：“高手术”患者（HS），采用 Roux 再次切除术和 TADE 手术；“低手术”（LS）患者，采用“不切断”技术和/或 Braun/GEA 吻合术治疗。使用 Eckhauser 量表和 Visick 量表对两组患者的手术结果进行比较分析。
第一组的 11 例患者中，8 例行 Roux 再次切除术，3 例行 TADE 手术；而第二组的患者中，4 例行 Braun/不切断输入袢闭合术，其余患者在此基础上联合 GEA 手术。两组均无死亡率，而 HS 组仅 1 例患者出现术后并发症。LS 组的 Visick 评分和 Eckauser 评分均更好。
收集的数据表明，即使 SPG 代表一组异质性临床病症，但通常可采用尽可能保守的外科手术进行治疗。这一结论可能为 SPG 的腹腔镜治疗开辟新的思路。
