全胃切除調節型雙通道間置空腸消化道重建_《中國普外基礎與臨床雜志》

作者：

肖仕明 , 姜淮蕪 , 陳進 , 肖平 , 郭海燕 , 孫燕

川北醫學院附屬第二醫院普外二科(四川綿陽621000);

關鍵詞：

功能性空腸間置代胃術,　　改良,　　全胃切除,　　消化道重建

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摘　要： 目的介紹一種新的全胃切除消化道重建術.方法選取我院2004年6月至2006年3月期間行全胃切除病例38例.在行消化道重建時,對功能性空腸間置代胃(FJI)術作如下改良: 將輸出袢適度絲線結扎改為部分縮窄縫合2～3針,適當縮短輸入袢腸管至20～25 cm,Braun吻合口距Treitz韌帶10 cm,以食管空腸及Braun吻合口無張力為度.結果全組病例無圍手術期死亡、吻合口漏及傾倒綜合征發生.Roux-en-Y滯留綜合征2例; 返流性食管炎1例; Visick分級: 35例Ⅰ級, 3例Ⅱ級.血清營養學指標: 僅2例血紅蛋白低于正常.術后6個月,36例進食量和體重恢復術前水平,僅2例體重下降.造影鋇劑主要進入十二指腸通道,少量通過部分縮窄通道.結論對FJI重建術的改良,不僅保留了原法的全部優點,而且可進一步降低并發癥,改善患者生活質量,但需進行進一步的前瞻性對比研究.

引用本文： 肖仕明,姜淮蕪,陳進,肖平,郭海燕,孫燕. 全胃切除調節型雙通道間置空腸消化道重建. 中國普外基礎與臨床雜志, 2008, 15(1): 23-26. doi: 復制

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2.	陳志新,胡建昆,于永揚,等.近、遠端胃癌臨床病理特點分析(附428例報告)[J].中國普外基礎與臨床雜志,2002; 9(3)∶151.
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6.	尹浩然.從術式演變談全胃切除術后消化道重建的原則[J].中華胃腸外科雜志,2004; 7(1)∶12.
7.	Chadha MK,Kuvshinoff BW,Javle MM.Neoadjuvant therapy for gastric cancer[J].Oncology (Williston Park),2005; 19(9)∶1219.
8.	Zherlov G,Koshel A,Orlova Y,et al.New type of jejunal interposition method after gastrectomy[J].World J Surg,2006; 30(8)∶1475.
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10.	朱正綱.全胃切除與消化道重建術在胃癌治療中的臨床意義[J].中國普外基礎與臨床雜志,2006; 13(1)∶15.
11.	張朝軍,羅云生,葛海燕,等.全胃切除術后保留幽門環間置空腸重建消化道術式的應用[J].中國普外基礎與臨床雜志,2003; 10(5)∶497.
12.	Ichikura T,Tomimatsu S,Uefuji K,et al.Evaluation of the New American Joint Committee on Cancer/International Union against cancer classification of lymph node metastasis from gastric carcinoma in coparison with the Japanese classification[J].Cancer,1999; 86(4)∶553.
13.	肖仕明,姜淮蕪,陳進,等.全胃切除改良空腸間置法胃腸道重建[J].中國現代普通外科進展,2006; 9(2)∶120.
14.	Roukos DH.Current advances and changes in treatment strategy may improve survival and quality of life in patients with potentially curable gastric cancer[J].Ann Surg Oncol,1999; 6(1)∶46.
15.	Ajani JA,Mansfield PF,Janjan N,et al.Multi-institutional trial of preoperative chemoradiotherapy in patients with potentially resectable gastric carcinoma[J].J Clin Oncol,2004; 22(14)∶2774.
16.	Sastre J,Garcia-Saenz JA,Diaz-Rubio E.Chemotherapy for gastric cancer[J].World J Gastroenterol,2006; 12(2)∶204.
17.	den Dulk M,Verheij M,Cats A,et al.The essentials of locoregional control in the treatment of gastric cancer[J].Scand J Surg,2006; 95(4)∶236.
18.	Kodera Y,Fujiwara M,Koike M,et al.Chemotherapy as a component of multimodal therapy for gastric carcinoma[J].World J Gastroenterol,2006; 12(13)∶2000.
19.	Macdonald JS.Role of post-operative chemoradiation in resected gastric cancer[J].J Surg Oncol,2005; 90(3)∶166.
20.	Ogoshi K,Okamoto Y,Nabeshima K,et al.Focus on the conditions of resection and reconstruction in gastric cancer.What extent of resection and what kind of reconstruction provide the best outcomes for gastric cancer patients?[J].Digestion,2005; 71(4)∶213.
21.	陳峻青.全胃切除消化道重建術[A].見:譚毓銓,鄭扶民,葉舜民主編.手術創新與意外處理·普通外科卷[M].第2版.長春:吉林科學技術出版社,1999∶54～155.
22.	周建平,劉祺.胃癌全胃切除指征及消化道重建術[J].中國現代手術學雜志,2002; 6(2)∶159.

1. <><><> [1]季加孚.全胃切除術后的消化道重建[J].中國實用外科雜志,2004; 24(9)∶516.
2. 陳志新,胡建昆,于永揚,等.近、遠端胃癌臨床病理特點分析(附428例報告)[J].中國普外基礎與臨床雜志,2002; 9(3)∶151.
3. Gaca JG,Petersen RP,Peterson BL,et al.Pathologic nodal status predicts disease-free survival after neoadjuvant chemoradiation for gastroesophageal junction carcinoma[J].Ann Surg Oncol,2006; 13(3)∶340.
4. 郝希山,李強,張忠國.胃癌患者全胃切除術后消化道重建方式的臨床研究[J].中華胃腸外科雜志,2003; 6(2)∶89.
5. 李榮,羅成華.全胃切除后消化道重建的術式選擇與創新[J].中華胃腸外科雜志,2004; 7(1)∶7.
6. 尹浩然.從術式演變談全胃切除術后消化道重建的原則[J].中華胃腸外科雜志,2004; 7(1)∶12.
7. Chadha MK,Kuvshinoff BW,Javle MM.Neoadjuvant therapy for gastric cancer[J].Oncology (Williston Park),2005; 19(9)∶1219.
8. Zherlov G,Koshel A,Orlova Y,et al.New type of jejunal interposition method after gastrectomy[J].World J Surg,2006; 30(8)∶1475.
9. 詹文華.循證醫學和全胃切除后消化道重建[J].中國實用外科雜志,2004; 24(9)∶514.
10. 朱正綱.全胃切除與消化道重建術在胃癌治療中的臨床意義[J].中國普外基礎與臨床雜志,2006; 13(1)∶15.
11. 張朝軍,羅云生,葛海燕,等.全胃切除術后保留幽門環間置空腸重建消化道術式的應用[J].中國普外基礎與臨床雜志,2003; 10(5)∶497.
12. Ichikura T,Tomimatsu S,Uefuji K,et al.Evaluation of the New American Joint Committee on Cancer/International Union against cancer classification of lymph node metastasis from gastric carcinoma in coparison with the Japanese classification[J].Cancer,1999; 86(4)∶553.
13. 肖仕明,姜淮蕪,陳進,等.全胃切除改良空腸間置法胃腸道重建[J].中國現代普通外科進展,2006; 9(2)∶120.
14. Roukos DH.Current advances and changes in treatment strategy may improve survival and quality of life in patients with potentially curable gastric cancer[J].Ann Surg Oncol,1999; 6(1)∶46.
15. Ajani JA,Mansfield PF,Janjan N,et al.Multi-institutional trial of preoperative chemoradiotherapy in patients with potentially resectable gastric carcinoma[J].J Clin Oncol,2004; 22(14)∶2774.
16. Sastre J,Garcia-Saenz JA,Diaz-Rubio E.Chemotherapy for gastric cancer[J].World J Gastroenterol,2006; 12(2)∶204.
17. den Dulk M,Verheij M,Cats A,et al.The essentials of locoregional control in the treatment of gastric cancer[J].Scand J Surg,2006; 95(4)∶236.
18. Kodera Y,Fujiwara M,Koike M,et al.Chemotherapy as a component of multimodal therapy for gastric carcinoma[J].World J Gastroenterol,2006; 12(13)∶2000.
19. Macdonald JS.Role of post-operative chemoradiation in resected gastric cancer[J].J Surg Oncol,2005; 90(3)∶166.
20. Ogoshi K,Okamoto Y,Nabeshima K,et al.Focus on the conditions of resection and reconstruction in gastric cancer.What extent of resection and what kind of reconstruction provide the best outcomes for gastric cancer patients?[J].Digestion,2005; 71(4)∶213.
21. 陳峻青.全胃切除消化道重建術[A].見:譚毓銓,鄭扶民,葉舜民主編.手術創新與意外處理·普通外科卷[M].第2版.長春:吉林科學技術出版社,1999∶54～155.
22. 周建平,劉祺.胃癌全胃切除指征及消化道重建術[J].中國現代手術學雜志,2002; 6(2)∶159.

《中國普外基礎與臨床雜志》

全胃切除調節型雙通道間置空腸消化道重建

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

Format

Content

《中國普外基礎與臨床雜志》

全胃切除調節型雙通道間置空腸消化道重建

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

Format

Content

摘要全文圖表視頻參考文獻施引文獻補充材料