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目的探讨胃次全切除术时采用连续性空肠间置完成消化道重建的临床效果。方法远端胃癌患者34例,随机分成两组,A组16例,B组18例。胃次全切除后,A组行残胃与空肠、十二指肠与空肠的端侧吻合,再行空肠侧侧吻合,将胃空肠吻合的输入袢空肠和十二指肠空肠吻合口的输出袢空肠分别结扎阻断,形成完整的连续性间置空肠代胃。B组行BillrothⅡ式消化道重建。比较两组患者术后并发症发生率和死亡率;术后1年比较两组患者的Visick分级指数、血浆白蛋白水平、每餐进食量和体重,并用胃镜检查残胃和吻合口情况。结果两组患者术后均未出现并发症。术后1年观察,Visick分级指数两组比较,u=2.1,P<0.05;差异有统计学意义。A组所有患者平均每日进食量均在术前水平的85%以上,B组只有14人达到该水平。两组手术前后体重减少值比较,t=-2.181,P<0.05;差异有统计学意义。两组手术前后血浆白蛋白变化值对比,差异有统计学意义(t=2.125,P<0.05);A组在1年后显著增加,与术前相比(t=-2.175,P<0.05)差异有统计学意义。手术后1年胃镜复查,A组残胃未发现胆汁反流,吻合口通畅,吻合口黏膜和间置空肠无充血、水肿,而B组发现残胃内胆汁潴留11例(61.1%),吻合口炎症13例(72.2%),吻合口溃疡2例(11.1%)。结论连续性空肠间置能够恢复消化道生理通道并避免反流性胃炎的发生。
Objective To investigate the clinical effect of continuous jejunum interposition to complete digestive tract reconstruction during subtotal gastrectomy. Methods 34 patients with distal gastric cancer were randomly divided into two groups: 16 cases in group A and 18 cases in group B. After subtotal gastrectomy, group A, the residual gastric and jejunum, end of the duodenum and jejunum anastomosis, and then the side of the jejunum anastomosis, the enterojejunostomy enterojejunostomy and duodenum jejunum anastomotic output袢 jejunum were ligation blocked, forming a complete continuity of the intercostal space on behalf of the stomach. Group B, Billroth Ⅱ digestive reconstruction. Complications and mortality rates were compared between the two groups. Visick grading index, plasma albumin level, food intake and body weight were compared between the two groups one year after operation. Results No complications occurred in both groups after operation. One year after the operation, Visick grading index was compared between the two groups, u = 2.1, P <0.05; the difference was statistically significant. The average daily food intake for all patients in group A was above 85% of the preoperative level, and only 14 in group B reached that level. Body weight loss before and after the two groups were compared, t = -2.181, P <0.05; the difference was statistically significant. Compared with preoperative and postoperative serum albumin, the difference was statistically significant (t = 2.125, P <0.05) The difference was statistically significant. Gastroscopy was performed one year after surgery. No residual bile reflux was found in group A, and anastomosis was unobstructed. There was no congestion and edema in anastomotic mucosa and jejunum. In group B, 11 cases (61.1%) had residual bile retention, Oral inflammation in 13 cases (72.2%), anastomotic ulcer in 2 cases (11.1%). Conclusion Continuous jejunal interposition can restore the physiological pathway of gastrointestinal tract and prevent the occurrence of reflux gastritis.