肿瘤患者全胃切除连续间置空肠代胃消化道重建术观察

摘要

背景与目的:全胃切除术后患者易出现的低体重、反流性食管炎和严重的倾倒综合征等情况,严重地影响着患者的生活质量.积极探索一种理想的消化道重建方式,以减轻患者术后消化功能紊乱的症状,改善其生活质量是我们追求的目标.本研究旨在通过检测全胃切除术后患者体质量、血液指标、代胃容量变化,探讨连续间置空肠代胃消化道重建术在全胃切除后的应用价值.方法:对2000年1月-2010年3月间42例行全胃切除连续间置空肠代胃术的患者的临床资料进行分析.结果:全组患者无手术死亡和吻合口漏发生.随访12～24个月,平均17.4个月.术后6、12个月患者血红蛋白、外周血淋巴细胞数较术前有所提高.其中钡餐检查11例,代胃容量均在300mL以上,胃排空时间为30～120min.术后6、12个月分别有11例和4例患者出现反流性食管炎.与术前相比,患者术后生活质量有所提高.结论:全胃切除术采用连续间置空肠代胃消化道重建术,恢复食物经过十二指肠通道,对降低患者全胃切除术后的并发症和提高患者生活质量具有重要意义.%Background and purpose: Symptoms would always occurred in patients underwent total gastrectomy, like low weight, reflux esophagitis and serious dumping syndrome and so on, which seriously affect the quality of life of the patients. It is the common purpose to explore an ideal way of digestive tract reconstruction to relieve the digestion disorders symptom of the patients after the surgery and to improve their quality of life. This research aimed to discuss the application values of digestive tract reconstruction by continuous jejunal interposition after total gastrectomy through inspecting the weight, blood index and reconstructed stomach capacity. Methods:Forty-two cases with stomach cancer underwent digeslive tract reconstruction by continuous jejunal interposition after total gastrectomy between Jan. 2000 to Mar. 2010, and all the characteristics of the patients were analyzed. Results:No operative death and stomach fistula was found in all cases. The follow-up period ranged from 12 to 24 months (average 17.4 months). The number of hemoglobin and lymphocyte of the patients has increased 6 and 12 months after postoperative. Eleven cases in the series were examined by barium meal. The volume of artificial stomach was more than 300 mL and the emptying time was 30 to 120 minutes. Reflux esophagitis was found in 11 cases at 6 months and 4 cases at 12 months after operation. The quality of life was improved postoperation. Conclusion: Digestive tract reconstruction by continuous jejunal interposition after total gastrectomy is an effective method to improve the quality of life, to reduce complications after gastrectomy and to maintain the canal of the chyme through the duodenal tract.