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[胃十二指肠溃疡行无反流胃切除及 Roux-en-Y 吻合术后的结果]

[Results following reflux-free stomach resection with Roux-en-Y anastomosis in gastroduodenal ulcer].

作者信息

Mättig H, Schneider G, Wiesenhaken U, Wohlgemuth B, Goerl R

出版信息

Zentralbl Chir. 1987;112(5):303-11.

PMID:3591048
Abstract

The ulcer risk of Billroth-II-Y-Roux anastomosis, following distal two-third to three-quarter gastrectomy for complicated duodenal ulcer, ventricular ulcer, and pepto-jejunal ulcer was checked in 29 of 31 patients after surgery. (One patient had died after the operation and one rejected follow-up check for absence of complaints.) The same group of 29 patients underwent postoperative clinical examinations 1.6 years later, with additional nucleomedical, endoscopico-bioptic, and histological tests applied to 27 and additional secretion analysis to twelve of them. Twenty-eight patients were rechecked by Visick grading, approximately 3.9 years, following surgery. All 29 or 28 patients were clinically found to be in keeping with Visick I and II (100 per cent). Nucleomedical and endoscopic examinations did not reveal reflux in any of the 27 patients thus tested, and no recurrent ulcer was endoscopically recorded. Three patients refused to undergo endoscopy for absence of complaints. The time span of postoperative follow-up checks was as short as 1.6 years on average (between ten months and 4.5 years). Only trend information could, therefore, be derived from the histomorphological findings regarding minor mucosal changes, as compared to conventional techniques of resection. Reflux-free Y-Roux repair may be recommended as a mucosa-productive technique without increased ulcer risk, provided that gastrectomy is performed about 2 cm to 4 cm distal to the cardia.

摘要

对31例因复杂性十二指肠溃疡、胃溃疡和胃空肠溃疡行远端三分之二至四分之三胃切除术后行Billroth-II-Y-Roux吻合术的患者中的29例进行了术后溃疡风险检查。(1例患者术后死亡,1例因无不适拒绝随访检查。)同一组29例患者在术后1.6年接受了临床检查,其中27例还接受了核医学、内镜活检和组织学检查,12例进行了额外的分泌分析。28例患者在术后约3.9年通过Visick分级进行复查。临床发现所有29例或28例患者均符合Visick I级和II级(100%)。核医学和内镜检查未在接受检查的27例患者中发现反流,内镜检查未记录到复发性溃疡。3例患者因无不适拒绝接受内镜检查。术后随访检查的平均时间跨度短至1.6年(10个月至4.5年)。因此,与传统切除技术相比,从关于微小黏膜变化的组织形态学发现中只能得出趋势性信息。如果在距贲门远端约2 cm至4 cm处进行胃切除术,无反流的Y-Roux修复术可作为一种不增加溃疡风险的黏膜生成技术推荐使用。

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