根治性近端胃切除術后的兩種重建術式評價_《中國普外基礎與臨床雜志》

作者：

肖仕明 , 姜淮蕪 , 吳宸 , 歐榮冊 , 陳進 , 肖琳

川北醫學院附屬第二醫院普外二科(四川綿陽621000);

關鍵詞：

胃腫瘤次全胃切除消化道重建間置空腸調節型雙通道

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目的　探討近端胃癌根治術后合理的消化道重建方式。
方法　回顧性總結2004年6月至2007年1月期間我院行近端胃癌次全胃切除連續病例59例,依據重建方式分為2組：胃食管側端吻合重建組(GE組)和調節型雙通道間置空腸重建組(GIE組),GIE組重建在殘胃與食管間增加一段長35 cm的連續性間置空腸,對比分析2組術后患者生活質量狀況。
結果　全組病例無圍手術期死亡、吻合口漏、傾倒綜合征及中度以上貧血病例發生。術后1和6個月體重、RBC、Hb、Alb、PNI值以及其相對于術前的變化值〔術后1個月RBC(P=0.006)、Hb(P=0.001)相對于術前的變化值除外〕,GIE組和GE組間差異均無統計學意義(P gt;0.05)。GIE組術后腹部癥狀和反流性食管炎癥狀的Visick評分優于GE組(P＜0.001): GIE組主要為Ⅱ級(74.2%),GE組主要為Ⅲ級(64.3%)。與GE組比較，GIE組術后并未延遲首次化療時間(P gt;0.05),手術時間延長(0.35±0.13) h (P=0.01)。
結論　調節型雙通道間置空腸消化道重建在近端胃次全切除術中是安全、可行的,有利于防止癌細胞殘留和改善近端胃癌根治術后患者生活質量。

引用本文： 肖仕明,姜淮蕪,吳宸,歐榮冊,陳進,肖琳. 根治性近端胃切除術后的兩種重建術式評價. 中國普外基礎與臨床雜志, 2008, 15(9): 682-685. doi: 復制

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2.	Paimela H, Ketola S, Iivonen M, et al. Long-term results after surgery for gastric cancer with or without jejunal reservoir: results of surgery for gastric cancer in Kanta-Hme central hospital in two consecutive periods without or with jejunal pouch reconstruction in 1985－1998 [Ｊ]. Int J Gastrointest Cancer, 2005; 36(3)∶147.
3.	Kretzschmar A, Schlag PM. Efficacy of current adjuvant and neoadjuvant therapeutic concepts in gastric cancer? [Ｊ]. Zentralbl Chir, 2006; 131(2)∶121.
4.	Gonzalez RJ, Mansfield PF. Adjuvant and neoadjuvant therapy for gastric cancer [Ｊ]. Surg Clin North Am, 2005; 85(5)∶1033.
5.	Menges M. Diagnosis, staging and therapy of gastric cancer [Ｊ]. Z Gastroenterol, 2004; 42(8)∶767.
6.	Chadha MK, Kuvshinoff BW, Javle MM. Neoadjuvant therapy for gastric cancer [Ｊ]. Oncology (Williston Park), 2005; 19(9)∶1219.
7.	肖仕明, 姜淮蕪, 陳進, 等. 全胃切除調節型雙通道間置空腸消化道重建 [Ｊ]. 中國普外基礎與臨床雜志, 2008; 15(1)∶23.
8.	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.
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10.	詹文華. 消化道重建：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.
11.	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.
12.	Visick AH. Measured radical gastrectomy: review of 505 operations for peptic ulcer [Ｊ]. Lancet, 1948; 1〖KG-*3〗∶505.
13.	Onodera T, Goseki N, Kosaki G. Prognostic nutritional index in gastrointestinal surgery of malnourished cancer patients [Ｊ]. Nippon Geka Gakkai Zasshi, 1984; 85(9)∶1001.
14.	Leong T. Chemotherapy and radiotherapy in the management of gastric cancer [Ｊ]. Curr Opin Gastroenterol, 2005; 21(6)∶673.
15.	Lim L, Michael M, Mann GB, et al. Adjuvant therapy in gastric cancer [Ｊ]. J Clin Oncol, 2005; 23(25)∶6220.
16.	Berardi R, Scartozzi M, Romagnoli E, et al. Gastric cancer treatment: a systematic review [Ｊ]. Oncol Rep, 2004; 11(4)∶911.
17.	Varadhachary G, Ajani JA. Preoperative and adjuvant therapies for upper gastrointestinal cancers [Ｊ]. Expert Rev Anticancer Ther, 2005; 5(4)∶719.
18.	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.
19.	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.
20.	Iwata T, Kurita N, Ikemoto T, et al. Evaluation of reconstruction after proximal gastrectomy: prospective comparative study of jejunal interposition and jejunal pouch interposition [Ｊ]. Hepatogastroenterology, 2006; 53(68)∶301.
21.	Takeshita K, Sekita Y, Tani M. Medium- and long-term results of jejunal pouch reconstruction after a total and proximal gastrectomy [Ｊ]. Surg Today, 2007; 37(9)∶754.
22.	Katsoulis IE, Robotis JF, Kouraklis G, et al. What is the difference between proximal and total gastrectomy regarding postoperative bile reflux into the oesophagus? [Ｊ]. Dig Surg, 2006; 23(5-6)∶325.

1. 　Harder J, Opitz OG. Gastric cancer——risk factors and medical therapy [Ｊ]. Schweiz Rundsch Med Prax, 2006; 95(25-26)∶1021.
2. 　Paimela H, Ketola S, Iivonen M, et al. Long-term results after surgery for gastric cancer with or without jejunal reservoir: results of surgery for gastric cancer in Kanta-Hme central hospital in two consecutive periods without or with jejunal pouch reconstruction in 1985－1998 [Ｊ]. Int J Gastrointest Cancer, 2005; 36(3)∶147.
3. 　Kretzschmar A, Schlag PM. Efficacy of current adjuvant and neoadjuvant therapeutic concepts in gastric cancer? [Ｊ]. Zentralbl Chir, 2006; 131(2)∶121.
4. 　Gonzalez RJ, Mansfield PF. Adjuvant and neoadjuvant therapy for gastric cancer [Ｊ]. Surg Clin North Am, 2005; 85(5)∶1033.
5. 　Menges M. Diagnosis, staging and therapy of gastric cancer [Ｊ]. Z Gastroenterol, 2004; 42(8)∶767.
6. 　Chadha MK, Kuvshinoff BW, Javle MM. Neoadjuvant therapy for gastric cancer [Ｊ]. Oncology (Williston Park), 2005; 19(9)∶1219.
7. 　肖仕明, 姜淮蕪, 陳進, 等. 全胃切除調節型雙通道間置空腸消化道重建 [Ｊ]. 中國普外基礎與臨床雜志, 2008; 15(1)∶23.
8. 　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.
9. 　梁寒, 郝希山. 胃癌術式對患者術后營養的影響 [Ｊ]. 中國腫瘤臨床, 2007; 34(12)∶716.
10. 　詹文華. 消化道重建：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.
11. 　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.
12. 　Visick AH. Measured radical gastrectomy: review of 505 operations for peptic ulcer [Ｊ]. Lancet, 1948; 1〖KG-*3〗∶505.
13. 　Onodera T, Goseki N, Kosaki G. Prognostic nutritional index in gastrointestinal surgery of malnourished cancer patients [Ｊ]. Nippon Geka Gakkai Zasshi, 1984; 85(9)∶1001.
14. 　Leong T. Chemotherapy and radiotherapy in the management of gastric cancer [Ｊ]. Curr Opin Gastroenterol, 2005; 21(6)∶673.
15. 　Lim L, Michael M, Mann GB, et al. Adjuvant therapy in gastric cancer [Ｊ]. J Clin Oncol, 2005; 23(25)∶6220.
16. 　Berardi R, Scartozzi M, Romagnoli E, et al. Gastric cancer treatment: a systematic review [Ｊ]. Oncol Rep, 2004; 11(4)∶911.
17. 　Varadhachary G, Ajani JA. Preoperative and adjuvant therapies for upper gastrointestinal cancers [Ｊ]. Expert Rev Anticancer Ther, 2005; 5(4)∶719.
18. 　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.
19. 　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.
20. 　Iwata T, Kurita N, Ikemoto T, et al. Evaluation of reconstruction after proximal gastrectomy: prospective comparative study of jejunal interposition and jejunal pouch interposition [Ｊ]. Hepatogastroenterology, 2006; 53(68)∶301.
21. 　Takeshita K, Sekita Y, Tani M. Medium- and long-term results of jejunal pouch reconstruction after a total and proximal gastrectomy [Ｊ]. Surg Today, 2007; 37(9)∶754.
22. 　Katsoulis IE, Robotis JF, Kouraklis G, et al. What is the difference between proximal and total gastrectomy regarding postoperative bile reflux into the oesophagus? [Ｊ]. Dig Surg, 2006; 23(5-6)∶325.

《中國普外基礎與臨床雜志》

根治性近端胃切除術后的兩種重建術式評價

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《中國普外基礎與臨床雜志》

根治性近端胃切除術后的兩種重建術式評價

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

Format

Content

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