Kobayashi I, Ohwada S, Ohya T, Yokomori T, Iesato H, Morishita Y
Department of Surgery, Ojiya General Hospital, Gunma, Japan.
Hepatogastroenterology. 1998 Mar-Apr;45(20):558-62.
BACKGROUND/AIMS: In this paper, we describe operative technique details and our results with a modified technique for jejunal pouch formation and interposition after total gastrectomy, with an overall aim to achieve results superior to jejunal pouch and Roux-en-Y reconstruction, as reported in the literature.
Following total gastrectomy, the jejunum was divided approximately 20 cm distal to the ligament of Treitz. Marginal vessels were not divided in order to preserve the nerves in the 50 cm of distal jejunum which would be used for pouch construction. The pouch was constructed using a linear stapler (Endo GiA, United States Surgical Corp., Norwalk, Conn). A total of 15 gastric cancer patients underwent construction of a nerve-preserving jejunal pouch and interposition following total gastrectomy.
None of the patients experienced postoperative complications due to pouch construction. Additionally, discomforts such as dumping or stagnation were not observed. Mild reflux esophagitis occurred in five of the 15 patients and was resolved by oral administration of camostat mesilate. Six months after surgery, the average patient's diet volume and body weight had gradually increased to 79% and 86%, respectively, of the presurgical levels. A dual phase, dual isotope radionucleid pouch emptying study was also performed six months after surgery. The intra-pouch RI retention rate was 47% for liquid food and 53% for solid food 120 minutes after intake. The emptying rate was slower for both solid and liquid food, as compared with healthy individuals.
The pouch-emptying test demonstrated a satisfactory retention capacity and an acceptable emptying time as a gastric substitute. The patients who underwent gastric reconstruction with a nerve-preserving jejunal pouch with interposition have experienced a reasonably good quality of life.
背景/目的：在本文中，我们描述了全胃切除术后空肠袋形成和间置改良技术的手术技术细节及结果，总体目标是取得优于文献报道的空肠袋和Roux-en-Y重建的效果。
全胃切除术后，在Treitz韧带远端约20 cm处切断空肠。为保留用于袋构建的50 cm远端空肠中的神经，未切断边缘血管。使用线性吻合器（Endo GiA，美国外科公司，康涅狄格州诺沃克）构建袋。共有15例胃癌患者在全胃切除术后接受了保留神经的空肠袋构建和间置术。
所有患者均未因袋构建出现术后并发症。此外，未观察到倾倒或停滞等不适。15例患者中有5例发生轻度反流性食管炎，通过口服甲磺酸加贝酯得以缓解。术后6个月，患者的平均饮食量和体重分别逐渐增加至术前水平的79%和86%。术后6个月还进行了双相、双同位素放射性核素袋排空研究。摄入后120分钟，流食的袋内放射性核素保留率为47%，固体食物为53%。与健康个体相比，固体和液体食物的排空率均较慢。
袋排空试验显示作为胃替代物具有令人满意的保留能力和可接受的排空时间。接受保留神经的空肠袋间置胃重建术的患者生活质量相当良好。
