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胃癌作全胃切除后用小肠代胃术式甚多,但术后进餐症状和营养状况不尽人意.日本大阪Kansai医科大学第二外科在1988年11月至1993年2月,对胃癌作全胃切除术后空肠代胃重建术式进行前瞻性随机对照研究,试从中选择最佳术式.病人和方法:30位年龄小于70岁在该院作根治性全胃切除术的胃癌患者,Ⅳ期病例除外,按随机化原则分3组,每组10人,计有Roux-en-Y食管空肠吻合组(RY)、空肠袋Roux-en-Y组(PR)和空肠袋及空肠间置组(PI).年龄、性别、病程分期、淋巴清除、器官联合切除和术后并发症三组无明显差异.RY重建:屈氏韧带下20cm切断空肠,结肠后提出,关闭肠腔与食管作端侧吻合,距断端40cm再与近端空肠作端侧吻合.PR重建:先作Hunt-Lawrence袋,空肠在屈氏韧带下切断,结肠后提出.距断端20cm处返折,食管与折顶处空肠行端侧吻合,折叠空肠在系膜对侧缘用自动线状吻合器作侧侧吻合,关闭残端并检查有无渗漏,最后距袋下缘20cm完成Roux吻合.PI重建空肠袋如PR一样,袋下20cm作空肠十二指肠端端吻合,屈氏韧带下20Cm完成Roux吻合.术后均禁食7天,静脉高价营养,进食前X线检查以防有漏.Ⅱ、Ⅲ期病人术后6～12月口服氟尿嘧啶类药,Ⅲ期患者另加MMC或ADM.观察12个月,在RY、PR和PI组无复发分别有8、9和6人.经血清肿瘤标记、内窥镜.CT和超?
Gastric cancer after total gastrectomy with small intestine to replace the stomach surgery, but the symptoms and nutritional status of the meal after the meal is not satisfactory. Osaka, Kansai Medical University, Second Surgery in November 1988 to February 1993, for gastric cancer Gastrointestinal Gastric Reconstructive Surgery after Gastric Resection: A Prospective Randomized Controlled Trial to Select the Best Outcome. PATIENTS AND METHODS: Thirty gastric cancer patients under the age of less than 70 years who underwent radical total gastrectomy in this hospital, IV Except period, divided into 3 groups according to the principle of randomization, 10 in each group, including Roux-en-Y esophageal jejunostomy group (RY), jejunal bag Roux-en-Y group (PR) and jejunal bag and jejunum Group (PI). Age, gender, stage of disease, lymph node clearance, organ resection and postoperative complications were not significantly different between the three groups. RY reconstruction: 20 cm below the thoracic ligament, the jejunum was cut off, the colon was raised, and the lumen and esophagus were closed. End-to-side anastomosis, 40 cm from the commissure and end-to-side anastomosis with the proximal jejunum. PR reconstruction: First Hunt-Lawrence bag, jejunum was cut off under the flexor ligament, the colon was raised, 20 cm from the fractured end, esophagus and At the top of the fold, the jejunum was anastomosed end-to-side, and the folded jejunum was used for side-to-side anastomosis with an automatic linear stapler on the opposite side of the mesangium. Close the stump and check whether there is leakage, and finally complete the Roux anastomosis 20cm from the lower edge of the bag. The PI reconstruction jejunal bag is the same as the PR, and 20cm under the bag is used for jejunum-duodenal end-to-end anastomosis. The Roux anastomosis is performed at 20Cm below the thoracic ligament. Postoperative fasting for 7 days, intravenous high-priced nutrition, X-ray examination before eating to prevent leakage. Phase II, III patients were given oral fluorouracil after 6 to 12 months, and patients with stage III plus MMC or ADM. Observed 12 On month, there were no recurrences in the RY, PR, and PI groups with 8, 9 and 6 patients respectively. The serum tumor markers, endoscopy, CT and ultrasonography.