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目的探讨近端胃切除后残胃与空肠双通道吻合在胃上部癌根治术中的价值。方法我院2007年1月至2009年6月期间对40例胃上部癌患者行近端胃根治性切除,保留远端胃,行食管-空肠端侧吻合、残胃-空肠侧侧吻合、空肠-空肠侧侧吻合的双通道消化道重建。结果本组病例距肿瘤远切缘>5cm,切缘阴性。清扫淋巴结(21±6)枚,符合D2根治术的规范。未发生吻合口漏、梗阻、出血等并发症。术后钡餐造影,部分钡剂经过残胃-十二指肠径路进入空肠,无钡剂返流入食管。随访6～30个月(平均18个月)患者无明显返流性食管炎;1例有轻微倾倒综合征表现;患者血红蛋白较术前均有明显升高,近期生活质量满意。结论近端胃根治性切除,保留远端胃,作残胃与空肠双通道吻合治疗胃上部癌,清扫、切除范围合理,残胃有一定储袋作用,能较好地预防返流性食管炎和倾倒综合征;保留了十二指肠径路,改善了生活质量,近期效果满意;手术重建结构简单,操作不复杂,难度小,是胃上部癌根治术较理想的消化道重建方式。
Objective To investigate the value of two-channel anastomosis of residual stomach and jejunum after radical gastrectomy in the radical operation of upper gastric cancer. Methods From January 2007 to June 2009, 40 cases of gastric upper carcinoma underwent radical radical resection in our hospital from January 2007 to June 2009. The distal stomach was preserved. The anastomosis of esophagus and end-side was performed. Double jejunum digestive tract reconstruction with lateral anastomosis. The results of this group of patients from the tumor far edge of> 5cm, negative margins. Sweeping lymph nodes (21 ± 6) pieces, in line with the D2 radical mastectomy. No anastomotic leakage, obstruction, bleeding and other complications. Postoperative barium meal angiography, part of the barium through the residual stomach - duodenum path into the jejunum, no reflux barium into the esophagus. Patients were followed up for 6 to 30 months (mean 18 months) without reflux reflux esophagitis; 1 case had mild dumping syndrome; patients had significantly higher hemoglobin than those before operation, and the quality of life was satisfactory recently. Conclusion proximal radical resection of the stomach to retain the distal stomach, as the stomach and jejunum gastrointestinal anastomosis two-channel anastomosis for the treatment of upper gastric cancer, a reasonable range of excision, gastric residual bag has a certain role, can better prevent reflux esophagitis And dumping syndrome; to retain the duodenal path, improve the quality of life, the recent satisfactory results; surgical reconstruction of simple structure, the operation is not complicated, the difficulty is small, radical gastrectomy is the ideal way of reconstruction of the digestive tract.