Department of Surgery, University of Heidelberg, Heidelberg, Germany.
Langenbecks Arch Surg. 2012 Jan;397(1):63-7. doi: 10.1007/s00423-011-0826-3. Epub 2011 Jul 15.
Various reconstruction methods with or without reservoir formation after total gastrectomy have been established. Transverse intestinoplasty has benefits as a functional peristalsis modification in rectal resections. In this study, we evaluate a distal pouch combined with a transverse jejunoplasty compared to standard Roux-en-Y reconstruction.
Total gastrectomy was performed on 23 pigs randomly assigned to 3 reconstruction groups-group 1 (n = 7): esophagojejunostomy without a pouch, group 2 (n = 8): esophagojejunostomy with a distal pouch, and group 3 (n = 8): distal pouch with a transverse jejunoplasty. Seven days postoperatively, weight was measured, and X-ray examinations were conducted for 1 h after oral contrast medium application. Blood glucose levels after oral glucose intake and the volume of the pouch loop were evaluated.
Upper jejunal passage was delayed and the mean volume of the jejunal loop increased by pouch formation compared to controls (p < 0.05). Body weight was the best for the pouch group with jejunoplasty (-1.9 ± 0.8% vs. pouch alone -3.3 ± 2.4% vs. no pouch -7.5 ± 2.1%, p < 0.05).
The distal jejunal pouch after total gastrectomy offers advantages with respect to bowel passage and postoperative nutrition status compared to standard Roux-en-Y reconstruction. The combination of a distal pouch and transverse jejunoplasty may provide additional functional benefits.
在全胃切除术后，已经建立了各种带有或不带有储袋形成的重建方法。横结肠成形术在直肠切除术中具有改善功能蠕动的优点。在这项研究中，我们评估了远端袋与横结肠成形术联合与标准 Roux-en-Y 重建的比较。
23 头猪随机分为 3 个重建组，组 1（n = 7）：无袋食管空肠吻合术，组 2（n = 8）：带远端袋食管空肠吻合术，组 3（n = 8）：带横结肠成形术的远端袋。术后 7 天，测量体重，并在口服造影剂后 1 小时进行 X 线检查。评估口服葡萄糖后血糖水平和袋环容积。
与对照组相比，袋形成后上空肠通过延迟，空肠环的平均容积增加（p < 0.05）。与单独带袋组（-3.3 ± 2.4%）和无袋组（-7.5 ± 2.1%）相比，带袋和横结肠成形术组的体重下降最佳（-1.9 ± 0.8%，p < 0.05）。
与标准 Roux-en-Y 重建相比，全胃切除术后远端空肠袋在肠通过和术后营养状态方面具有优势。远端袋与横结肠成形术的联合可能提供额外的功能益处。
