Stier A, Hölscher A H, Schwaiger M, Siewert J R
Chirurgische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München.
Zentralbl Chir. 1994;119(12):838-44.
The formation of a pouch is a surgical procedure to restore the lost of reservoir function after resection of the stomach. After total gastrectomy the intestinal passage can be reconstructed by a jejunal pouch performing a Siewert/Peiper esophagojejunoplication. Regarding the postoperative quality of life we supposed that there is an advantage for this reconstruction method compared to simple esophagojejunostomy. The following study investigated whether the pouch reconstruction by jejunoplication can develop a reservoir function and therefore a better clinical course compared to jejunostomy. Without evidence of a local recurrence after total gastrectomy 18 patients with and 18 without pouch reconstruction were evaluated by alimentary scintigraphy for at least 6 months after operation. Only patients were included with a tumor stage not exceeding T2 (UICC). The results of the transit times with a solid radioactively labelled test meal were correlated with the complaints and nutritional status of the patients, evaluated with a standardized questionary for creating an individual score note. The transit in a jejunal pouch follows a linear decreasing function and is significantly slower compared to the exponential passage of the jejunostomy. Both patterns remain still significantly accelerated compared to the physiological ranges of gastric emptying. Patients with a pouch judge their postoperative individual state better than patients with simple jejunostomy indicated with an on average symptom related score note better than 3. As long as the tumor stage is associated with a beneficial prognosis and the tumor localisation allows the reconstruction by an esophagojejunoplication the formation of a pouch after total gastrectomy is recommended because of an improved transit pattern and clinical course.
胃袋形成术是一种外科手术，用于在胃切除术后恢复丧失的储存功能。全胃切除术后，可通过行Siewert/Peiper食管空肠吻合术的空肠袋重建肠道通道。关于术后生活质量，我们认为与单纯食管空肠吻合术相比，这种重建方法具有优势。以下研究调查了与空肠造口术相比，通过空肠吻合术进行的胃袋重建是否能发挥储存功能，从而带来更好的临床病程。在全胃切除术后无局部复发证据的情况下，对18例行胃袋重建的患者和18例未行胃袋重建的患者在术后至少6个月进行了消化道闪烁扫描评估。仅纳入肿瘤分期不超过T2（国际抗癌联盟）的患者。用固体放射性标记试验餐测得的通过时间结果与患者的症状及营养状况相关，通过标准化问卷进行评估以创建个体评分记录。空肠袋内的通过呈线性下降函数，与空肠造口术的指数式通过相比明显较慢。与胃排空的生理范围相比，这两种模式仍明显加快。有胃袋的患者对其术后个体状态的评价优于单纯空肠造口术的患者，平均症状相关评分高于3分。只要肿瘤分期预后良好且肿瘤位置允许进行食管空肠吻合术重建，全胃切除术后建议行胃袋形成术，因为其通过模式和临床病程有所改善。
