带空肠袋的未切断Roux-en-Y：一种全胃切除术的新重建技术。

The uncut Roux-en-Y with jejunal pouch: a new reconstruction technique for total gastrectomy.

作者信息

Chaiyasate Kongkrit, Jacobs Michael, Brooks Steven E, del Rosario Gelen, Andrus Lee, Kestenberg William, Mittal Vijay

机构信息

Department of Surgery, Providence Hospital and Medical Centers, Southfield, MI 48075, USA.

出版信息

Surgery. 2007 Jul;142(1):33-9. doi: 10.1016/j.surg.2007.03.003.

DOI:10.1016/j.surg.2007.03.003

PMID:17629998

Abstract

BACKGROUND

Roux Stasis Syndrome is a well-known complication after Roux-en-Y reconstruction. It has been hypothesized that reconstruction with an uncut Roux limb and jejunal pouch after total gastrectomy would preserve unidirectional intestinal myoelectrical activity, improve postoperative weight gain and nutritional parameters, and diminish Roux Stasis Syndrome in canines.

METHODS

A total gastrectomy was performed, and 2 methods were used for reconstruction: Roux-en-Y esophagojejunostomy (RY) was performed on 5 canines (control), and the uncut Roux-en-Y with a jejunal pouch (URYJP) was performed on 5 other canines (experimental). The canines were monitored for 10 weeks postoperatively. Serial weight and nutritional parameters were measured. Emptying profiles and motility studies were performed in the fasting and postprandial states.

RESULTS

Ten weeks after operation, the URYJP group had significantly improved nutritional parameters, including weight, total protein, albumin, hemoglobin, serum total iron binding capacity, and serum IgA, IgG, and IgM. The emptying times for both groups were similar, with an increase of disordered propagation of the jejunal pacesetter potential in the RY group. The aboral propagation occurred more frequently in the URYJP group during fasting and after feeding (98% +/- 1% vs 39% +/- 16%; P = .02, and 99% +/- 1% vs 43% +/- 18%; P = .03). The sites of luminal occlusions were intact in the URYJP group at 10 weeks.

CONCLUSIONS

The combination of jejunal pouch and uncut Roux limb improved overall nutritional parameters when compared with the traditional Roux-en-Y, while preserving aboral propagation of jejunal pacesetter potentials.

摘要

背景

Roux滞留综合征是Roux-en-Y重建术后一种众所周知的并发症。有假说认为，全胃切除术后采用未切断的Roux袢和空肠袋进行重建可保留肠道单向肌电活动，改善术后体重增加和营养参数，并减少犬类的Roux滞留综合征。

方法

进行全胃切除术，并采用两种方法进行重建：对5只犬实施Roux-en-Y食管空肠吻合术（RY，对照组），对另外5只犬实施带空肠袋的未切断Roux-en-Y术（URYJP，实验组）。术后对犬进行10周监测。测量连续体重和营养参数。在禁食和餐后状态下进行排空曲线和动力研究。

结果

术后10周，URYJP组的营养参数显著改善，包括体重、总蛋白、白蛋白、血红蛋白、血清总铁结合力以及血清IgA、IgG和IgM。两组的排空时间相似，但RY组空肠起搏点电位的无序传播增加。URYJP组在禁食和进食后口向传播更为频繁（分别为98%±1%对39%±16%；P = 0.02，以及99%±1%对43%±18%；P = 0.03）。10周时URYJP组的管腔阻塞部位完整。