Ye Zai-yuan, Sun Yuan-shui, Shi Dun, Shao Qin-shu, Xu Ji
Department of General Surgery, Zhejiang Provincial People's Hospital, Hangzhou, China.
Zhonghua Wei Chang Wai Ke Za Zhi. 2008 Sep;11(5):424-7.
To investigate the efficacy of uncutted Roux-en-Y esophagojejunostomy with jejunal pouch (URYJP) after total gastrectomy.
Total gastrectomy was performed on 168 patients of gastric cancer, and 3 methods were used for reconstruction: the uncutted Roux-en-Y esophagojejunostomy with a jejunal pouch was performed on 69 patients(group A),Roux-en-Y esophagojejunostomy with the P-type jejunal pouch on 50 patients(group B),and Roux-en-Y esophagojejunostomy with the Orr-type jejunal pouch on 49 patients (group C). The alimentary tract reconstruction time, morbidity and mortality were compared. The 121 cases that survived for more than 1 year were analyzed for quality of life(QOL),including body weight, intake quantity, prognosis nutritional index (PNI), and Visick scores 6 and 12 months after the operations.
All the patients recovered quickly and no anastomosis leakage or duodenal fistulas were found. It took (30+/-7) minutes to finish the reconstruction in group A, which was significantly shorter than that in group B [(57+/-6) minutes] or in group C [(48+/-6) minutes]. There were no significant differences among 3 groups in the incidence of alkaline reflux gastritis. The incidence of Roux stasis syndrome was 2.2% in group A, which was significantly lower than 17.9% and 19.4% in group B and C. Weight loss and food intake gain in group A was superior to those in group B and C 6 months and 12 months postoperatively. As compared with prognosis nutritional index(PNI) postoperatively, those of 3 groups decreased significantly 6 months postoperatively. At 12 months after operation, the PNI of group A returned to the level before operation, while PNI of both group B and C remained significantly lower than those before operation (both P < 0.05). The Visick score of group A was superior to those of group B and C 6 months and 12 months postoperatively.
The new uncutted Roux operation with jejunal pouch can prevent alkaline reflux gastritis and Roux-en-Y stasis syndrome. It may be a standard procedure for reconstruction after total gastrectomy.
探讨全胃切除术后未离断Roux-en-Y食管空肠吻合加空肠袋（URYJP）的疗效。
对168例胃癌患者行全胃切除术，采用3种重建方法：69例患者行未离断Roux-en-Y食管空肠吻合加空肠袋（A组），50例患者行Roux-en-Y食管空肠吻合加P型空肠袋（B组），49例患者行Roux-en-Y食管空肠吻合加Orr型空肠袋（C组）。比较各组消化道重建时间、发病率及死亡率。对存活超过1年的121例患者分析其生活质量（QOL），包括术后6个月和12个月时的体重、摄入量、预后营养指数（PNI）及Visick评分。
所有患者恢复迅速，未发现吻合口漏或十二指肠瘘。A组重建时间为（30±7）分钟，明显短于B组[（57±6）分钟]和C组[（48±6）分钟]。3组间碱性反流性胃炎发生率差异无统计学意义。A组Roux滞留综合征发生率为2.2%，明显低于B组（17.9%）和C组（19.4%）。术后6个月和12个月时，A组体重减轻及食物摄入量增加情况优于B组和C组。与术后预后营养指数（PNI）相比，3组术后6个月时PNI均明显下降。术后12个月时，A组PNI恢复至术前水平，而B组和C组PNI仍明显低于术前水平（均P<0.05）。术后6个月和12个月时，A组Visick评分优于B组和C组。
新型未离断Roux加空肠袋手术可预防碱性反流性胃炎和Roux-en-Y滞留综合征。可能是全胃切除术后重建的标准术式。
