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虽然上消化道重建方式多种多样,但目前尚无被公认的最佳重建方式。上消化道重建后,一方面必须控制好并发症的发生率;另一方面要保证病人有满意的营养状态和良好的生存质量。胃癌根治术后的重建方式也是专家们一直讨论和研究的热点,一直受到大家的重视。全胃切除术后,Roux-en-Y吻合是一种简单、并发症少,又能满足功能要求的重建方式。对病期晚、预后差的进展期胃癌病人,Roux-en-Y吻合时不建议附加贮袋,对于良性肿瘤或者早期胃癌,可以附加重建贮袋,以期提高生存质量。远端胃大部切除术后,相对于BillrothⅠ式吻合来说,BillrothⅡ式或Roux-en-Y吻合重建术并发症少、肿瘤复发率低。BillrothⅠ式吻合重建的适用范围较为有限。近端胃大部切除术后,采用食管残胃(管状胃)吻合是较为常见的重建方式。幽门重建的作用还存在一定争议,有待进一步研究。
Although there are many ways to reconstruct upper gastrointestinal tract, no best way to rebuild is found. Upper gastrointestinal reconstruction, on the one hand, must control the incidence of complications; the other hand, to ensure that patients have a satisfactory nutritional status and good quality of life. The reconstruction of gastric cancer after radical reconstruction is also a hot topic that experts have been discussing and researching and has always been valued by all. After total gastrectomy, the Roux-en-Y anastomosis is a simple reconstruction with fewer complications and functional requirements. Late stage, poor prognosis of patients with advanced gastric cancer, Roux-en-Y does not recommend an additional storage bag anastomosis, for benign tumors or early gastric cancer, additional reconstruction of the pocket, in order to improve the quality of life. After distal gastrectomy, compared with Billroth Ⅰ anastomosis, Billroth Ⅱ or Roux-en-Y anastomosis reconstruction less complications, tumor recurrence rate is low. Billroth Ⅰ anastomosis reconstruction is more limited. After proximal gastrectomy, the use of esophageal stump (tubular stomach) anastomosis is a more common method of reconstruction. There is still some controversy over the role of pylori reconstruction, which needs further study.