• 川北醫(yī)學(xué)院附屬第二醫(yī)院普外二科(四川綿陽621000);

摘　要： 目的 介紹一種新的全胃切除消化道重建術(shù).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(shí),對(duì)功能性空腸間置代胃(FJI)術(shù)作如下改良: 將輸出袢適度絲線結(jié)扎改為部分縮窄縫合2～3針,適當(dāng)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(jié)果 全組病例無圍手術(shù)期死亡、吻合口漏及傾倒綜合征發(fā)生.Roux-en-Y滯留綜合征2例; 返流性食管炎1例; Visick分級(jí): 35例Ⅰ級(jí), 3例Ⅱ級(jí).血清營養(yǎng)學(xué)指標(biāo): 僅2例血紅蛋白低于正常.術(shù)后6個(gè)月,36例進(jìn)食量和體重恢復(fù)術(shù)前水平,僅2例體重下降.造影鋇劑主要進(jìn)入十二指腸通道,少量通過部分縮窄通道.結(jié)論 對(duì)FJI重建術(shù)的改良,不僅保留了原法的全部優(yōu)點(diǎn),而且可進(jìn)一步降低并發(fā)癥,改善患者生活質(zhì)量,但需進(jìn)行進(jìn)一步的前瞻性對(duì)比研究.

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

1. <><><> [1]季加孚.全胃切除術(shù)后的消化道重建[J].中國實(shí)用外科雜志,2004; 24(9)∶516.
2. 陳志新,胡建昆,于永揚(yáng),等.近、遠(yuǎn)端胃癌臨床病理特點(diǎn)分析(附428例報(bào)告)[J].中國普外基礎(chǔ)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(qiáng),張忠國.胃癌患者全胃切除術(shù)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.
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6. 尹浩然.從術(shù)式演變談全胃切除術(shù)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(yī)學(xué)和全胃切除后消化道重建[J].中國實(shí)用外科雜志,2004; 24(9)∶514.
10. 朱正綱.全胃切除與消化道重建術(shù)在胃癌治療中的臨床意義[J].中國普外基礎(chǔ)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(shù)后保留幽門環(huán)間置空腸重建消化道術(shù)式的應(yīng)用[J].中國普外基礎(chǔ)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(jìn),等.全胃切除改良空腸間置法胃腸道重建[J].中國現(xiàn)代普通外科進(jìn)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(shù)[A].見:譚毓銓,鄭扶民,葉舜民主編.手術(shù)創(chuàng)新與意外處理·普通外科卷[M].第2版.長春:吉林科學(xué)技術(shù)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(shù)[J].中國現(xiàn)代手術(shù)學(xué)雜志,2002; 6(2)∶159.
  1. 1. <><><> [1]季加孚.全胃切除術(shù)后的消化道重建[J].中國實(shí)用外科雜志,2004; 24(9)∶516.
  2. 2. 陳志新,胡建昆,于永揚(yáng),等.近、遠(yuǎn)端胃癌臨床病理特點(diǎn)分析(附428例報(bào)告)[J].中國普外基礎(chǔ)與臨床雜志,2002; 9(3)∶151.
  3. 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. 4. 郝希山,李強(qiáng),張忠國.胃癌患者全胃切除術(shù)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. 5. 李榮,羅成華.全胃切除后消化道重建的術(shù)式選擇與創(chuàng)新[J].中華胃腸外科雜志,2004; 7(1)∶7.
  6. 6. 尹浩然.從術(shù)式演變談全胃切除術(shù)后消化道重建的原則[J].中華胃腸外科雜志,2004; 7(1)∶12.
  7. 7. Chadha MK,Kuvshinoff BW,Javle MM.Neoadjuvant therapy for gastric cancer[J].Oncology (Williston Park),2005; 19(9)∶1219.
  8. 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. 9. 詹文華.循證醫(yī)學(xué)和全胃切除后消化道重建[J].中國實(shí)用外科雜志,2004; 24(9)∶514.
  10. 10. 朱正綱.全胃切除與消化道重建術(shù)在胃癌治療中的臨床意義[J].中國普外基礎(chǔ)與臨床雜志,2006; 13(1)∶15.
  11. 11. 張朝軍,羅云生,葛海燕,等.全胃切除術(shù)后保留幽門環(huán)間置空腸重建消化道術(shù)式的應(yīng)用[J].中國普外基礎(chǔ)與臨床雜志,2003; 10(5)∶497.
  12. 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. 13. 肖仕明,姜淮蕪,陳進(jìn),等.全胃切除改良空腸間置法胃腸道重建[J].中國現(xiàn)代普通外科進(jìn)展,2006; 9(2)∶120.
  14. 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. 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. 16. Sastre J,Garcia-Saenz JA,Diaz-Rubio E.Chemotherapy for gastric cancer[J].World J Gastroenterol,2006; 12(2)∶204.
  17. 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. 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. 19. Macdonald JS.Role of post-operative chemoradiation in resected gastric cancer[J].J Surg Oncol,2005; 90(3)∶166.
  20. 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. 21. 陳峻青.全胃切除消化道重建術(shù)[A].見:譚毓銓,鄭扶民,葉舜民主編.手術(shù)創(chuàng)新與意外處理·普通外科卷[M].第2版.長春:吉林科學(xué)技術(shù)出版社,1999∶54～155.
  22. 22. 周建平,劉祺.胃癌全胃切除指征及消化道重建術(shù)[J].中國現(xiàn)代手術(shù)學(xué)雜志,2002; 6(2)∶159.