• 上海市交通大學(xué)醫(yī)學(xué)院附屬第三人民醫(yī)院普外科（上海201900）;

目的 　通過建立大鼠全胃切除模型，探討全胃切除術(shù)后合理的消化道重建方式。
方法 　SD雄性大鼠60只，隨機均分為Roux-en-Y組（RY組）、近端空腸儲袋組（PJP組）、遠端空腸儲袋組（DJP組）、雙空腸儲袋組（TJP組）、十二指腸空腸儲袋間置組（DJPI組）和剖腹探查組（L組）6組，觀察和比較術(shù)后大鼠體重、腸道排空距離、食管空腸吻合口黏膜病理改變以及小腸黏膜形態(tài)學(xué)變化。
結(jié)果 　各組術(shù)后2周大鼠體重均較術(shù)前明顯減輕（P＜0.05），術(shù)后第 4周及8周體重開始逐漸恢復(fù)，PJP組、TJP組和DJPI組均較RY組恢復(fù)好（P＜0.05）。 PJP組與RY組相比，腸道排空距離縮短，排空減慢（P＜0.05）。 在小腸黏膜形態(tài)改變方面，TJP組和DJPI組與RY組間差異有統(tǒng)計學(xué)意義（P＜0.05）。 在返流性食管炎方面各組間差異均無統(tǒng)計學(xué)意義（P＞0.05）。
結(jié)論 　近端和雙空腸儲袋吻合術(shù)是全胃切除后消化道重建的理想術(shù)式，十二指腸空腸儲袋間置術(shù)也如此，但與前兩者比無明顯優(yōu)勢。

引用本文： 倪曉春,王和賢,卞邦健,張彪,姜波健. 全胃切除消化道重建的動物實驗研究. 中國普外基礎(chǔ)與臨床雜志, 2008, 15(8): 595-599. doi: 復(fù)制

1. 19　Kono K, Iizuka H, Sekikawa T, et al. Improved quality of life with jejunal pouch reconstruction after total gastrectomy [Ｊ]. Am J Surg, 2003; 185(2)∶ 150 20　Hoksch B, Zieren HU, Müller JM. Regular scintigraphic measurements of food transit following different types of reconstruction after total gastrectomy [Ｊ]. Arch Surg, 1999; 134(11)∶〖KG-7〗 1270.
2. 　Schuhmacher C, Bttcher K, Siewert JR. Intestinal pouches: gastric reconstruction [Ｊ]. Chirurg, 1999; 70(5)∶ 520.
3. 　Chin AC, Espat NJ. Total gastrectomy： options for the restoration of gastrointestinal continuity [Ｊ]. Lancet Oncol, 2003; 4(5)∶ 271.
4. 　Liedman B. Symptoms after total gastrectomy on food intake, body composition, bone metabolism, and quality of life in gastric cancer patients—is reconstruction with a reservoir worthwhile？ [Ｊ]. Nutrition, 1999; 15(9)∶ 677.
5. 　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.
6. 　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.
7. 　詹文華. 循證醫(yī)學(xué)解決全胃切除后消化道重建之紛爭 [Ｊ]. 中國普外基礎(chǔ)與臨床雜志， 2004； 11(2)∶ 100.
8. 　中華醫(yī)學(xué)會消化內(nèi)鏡學(xué)會, 中華消化內(nèi)鏡雜志編輯部. 返流性食管?。ㄑ祝┰\斷及治療方法（試行） [Ｊ]. 中華消化內(nèi)鏡雜志, 2000； 17(1)∶60.
9. 　Svedlund J, Sullivan M, Liedmen B, et al． Long term consequence of gastrectomy for patients quality of life： the impact of reconstructive techniques[Ｊ]. Am J Gastroenterol, 1999; 94(2)∶ 438.
10. 　Hoksch B, Ablassmaier B, Zieren J, et al. Quality of life after gastrectomy: Longmires reconstruction alone compared with additional pouch reconstruction [Ｊ]. World J Surg, 2002; 26(3)∶ 335.
11. 　Horváth OP, Kalmár K, Cseke L, et al. Nutritional and life-quality consequences of aboral pouch construction after total gastrectomy: a randomized, controlled study [Ｊ]. Eur J Surg Oncol, 2001; 27(6)∶ 558.
12. 　Murawa D, Murawa P, Oszkinis G, et al. Long-term consequences of total gastrectomy: quality of life, nutritional status, bacterial overgrowth and adaptive changes in esophagojejunostomic mucosa [Ｊ]. Tumori, 2006; 92(1)∶ 26.
13. 　Schwarz A, Büchler M, Usinger K, et al. Importance of the duodenal passage and pouch volume after total gastrectomy and reconstruction with the Ulm pouch: prospective randomized clinical study [Ｊ]. World J Surg, 1996; 20(1)∶ 66.
14. 　Nakane Y, Michiura T, Inoue K, et al. A randomized clinical trial of pouch reconstruction after total gastrectomy for cancer: which is the better technique, Roux-en-Y or interposition? [Ｊ]. Hepatogastroenterology, 2001; 48(39)∶ 903.
15. 　Fuchs KH, Thiede A, Engemann R, et al. Reconstruction of the food passage after total gastrectomy: randomized trial [Ｊ]. World J Surg, 1995; 19(5)∶ 698.
16. 　Adachi S, Takeda T, Fukao K. Evaluation of esophageal bile reflux after total gastrectomy by gastrointestinal and hepatobiliary dual scintigraphy [Ｊ]. Surg Today, 1999; 29(4)∶ 301.
17. 　Zonca P, Maly T, Herokova J, et al. Reconstruction after total gastrectomy [Ｊ]. Bratisl Lek Listy, 2002; 103(11)∶ 414.
18. 　Iivonen MK, Koskinen MO, Ikonen TJ, et al． Emptying of the jejunal pouch and Roux-en-Y limb after total gastrectomy-a randomized, prospective study [Ｊ]. Eur J Surg, 1999; 165(8)∶ 742.
19. 　Nakane Y, Akehira K, Okumura S, et al. Emptying of the jejunal pouch as a gastric substitute after total gastrectomy for cancer [Ｊ]. Hepatogastroenterology, 1997; 44(15)∶ 901.
20. 　Ohwada S, Sato Y, Oriuchi N, et al. Gastric emptying after segmental gastrectomy for early cancer in the middle part of the stomach [Ｊ]. Hepatogastroenterology, 1999; 46(27)∶ 2081.
21. 　Fujiwara Y, Kusunoki M, Nakagawa K, et al. Evaluation of J-pouch reconstruction after total gastrectomy: rho-double tract vs. J-pouch double tract [Ｊ]. Dig Surg, 2000; 17(5)∶ 475.
22. 　Tomita R, Fujisaki S, Tanjoh K, et al. Studies on gastrointestinal hormone and jejunal interdigestive migrating motor complex in patients with or without early dumping syndrome after total gastrectomy with Roux-en-Y reconstruction for early gastric cancer [Ｊ]. Am J Surg, 2003; 185(4)∶ 354.
23. 　Meyer L, Meyer F, Dralle H, et al. Insufficiency risk of esophagojejunal anastomosis after total abdominal gastrectomy for gastric carcinoma [Ｊ]. Langenbecks Arch Surg, 2005; 390(6)∶ 510.
24. 　Zherlov G, Koshel A, Orlova Y, et al. New type of jejunal interposition method after gastrectomy [Ｊ]. World J Surg, 2006; 30(8)∶ 1475.
25. 　楊培民. 全胃切除術(shù)后兩種代胃術(shù)式的比較 [Ｊ]. 中華胃腸外科雜志， 2006； 9(1)∶ 23.
26. 　Rea T, Bartolacci M, Leombruni E, et al. Study of the antireflux action of the Roux-en-Y jejunal loop in reconstruction after gastrectomy and nutritional status in the follow-up [Ｊ]. Ann Ital Chir, 2005; 76(4)∶ 343.
27. 　Yumiba T, Kawahara H, Nishida T, et al. Jejunal pouch interposition with fundic-like plication after total gastrectomy [Ｊ]. Surg Today, 2005; 35(8)∶ 623.
  1. 1. 19　Kono K, Iizuka H, Sekikawa T, et al. Improved quality of life with jejunal pouch reconstruction after total gastrectomy [Ｊ]. Am J Surg, 2003; 185(2)∶ 150 20　Hoksch B, Zieren HU, Müller JM. Regular scintigraphic measurements of food transit following different types of reconstruction after total gastrectomy [Ｊ]. Arch Surg, 1999; 134(11)∶〖KG-7〗 1270.
  2. 2. 　Schuhmacher C, Bttcher K, Siewert JR. Intestinal pouches: gastric reconstruction [Ｊ]. Chirurg, 1999; 70(5)∶ 520.
  3. 3. 　Chin AC, Espat NJ. Total gastrectomy： options for the restoration of gastrointestinal continuity [Ｊ]. Lancet Oncol, 2003; 4(5)∶ 271.
  4. 4. 　Liedman B. Symptoms after total gastrectomy on food intake, body composition, bone metabolism, and quality of life in gastric cancer patients—is reconstruction with a reservoir worthwhile？ [Ｊ]. Nutrition, 1999; 15(9)∶ 677.
  5. 5. 　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.
  6. 6. 　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.
  7. 7. 　詹文華. 循證醫(yī)學(xué)解決全胃切除后消化道重建之紛爭 [Ｊ]. 中國普外基礎(chǔ)與臨床雜志， 2004； 11(2)∶ 100.
  8. 8. 　中華醫(yī)學(xué)會消化內(nèi)鏡學(xué)會, 中華消化內(nèi)鏡雜志編輯部. 返流性食管病（炎）診斷及治療方法（試行） [Ｊ]. 中華消化內(nèi)鏡雜志, 2000； 17(1)∶60.
  9. 9. 　Svedlund J, Sullivan M, Liedmen B, et al． Long term consequence of gastrectomy for patients quality of life： the impact of reconstructive techniques[Ｊ]. Am J Gastroenterol, 1999; 94(2)∶ 438.
  10. 10. 　Hoksch B, Ablassmaier B, Zieren J, et al. Quality of life after gastrectomy: Longmires reconstruction alone compared with additional pouch reconstruction [Ｊ]. World J Surg, 2002; 26(3)∶ 335.
  11. 11. 　Horváth OP, Kalmár K, Cseke L, et al. Nutritional and life-quality consequences of aboral pouch construction after total gastrectomy: a randomized, controlled study [Ｊ]. Eur J Surg Oncol, 2001; 27(6)∶ 558.
  12. 12. 　Murawa D, Murawa P, Oszkinis G, et al. Long-term consequences of total gastrectomy: quality of life, nutritional status, bacterial overgrowth and adaptive changes in esophagojejunostomic mucosa [Ｊ]. Tumori, 2006; 92(1)∶ 26.
  13. 13. 　Schwarz A, Büchler M, Usinger K, et al. Importance of the duodenal passage and pouch volume after total gastrectomy and reconstruction with the Ulm pouch: prospective randomized clinical study [Ｊ]. World J Surg, 1996; 20(1)∶ 66.
  14. 14. 　Nakane Y, Michiura T, Inoue K, et al. A randomized clinical trial of pouch reconstruction after total gastrectomy for cancer: which is the better technique, Roux-en-Y or interposition? [Ｊ]. Hepatogastroenterology, 2001; 48(39)∶ 903.
  15. 15. 　Fuchs KH, Thiede A, Engemann R, et al. Reconstruction of the food passage after total gastrectomy: randomized trial [Ｊ]. World J Surg, 1995; 19(5)∶ 698.
  16. 16. 　Adachi S, Takeda T, Fukao K. Evaluation of esophageal bile reflux after total gastrectomy by gastrointestinal and hepatobiliary dual scintigraphy [Ｊ]. Surg Today, 1999; 29(4)∶ 301.
  17. 17. 　Zonca P, Maly T, Herokova J, et al. Reconstruction after total gastrectomy [Ｊ]. Bratisl Lek Listy, 2002; 103(11)∶ 414.
  18. 18. 　Iivonen MK, Koskinen MO, Ikonen TJ, et al． Emptying of the jejunal pouch and Roux-en-Y limb after total gastrectomy-a randomized, prospective study [Ｊ]. Eur J Surg, 1999; 165(8)∶ 742.
  19. 19. 　Nakane Y, Akehira K, Okumura S, et al. Emptying of the jejunal pouch as a gastric substitute after total gastrectomy for cancer [Ｊ]. Hepatogastroenterology, 1997; 44(15)∶ 901.
  20. 20. 　Ohwada S, Sato Y, Oriuchi N, et al. Gastric emptying after segmental gastrectomy for early cancer in the middle part of the stomach [Ｊ]. Hepatogastroenterology, 1999; 46(27)∶ 2081.
  21. 21. 　Fujiwara Y, Kusunoki M, Nakagawa K, et al. Evaluation of J-pouch reconstruction after total gastrectomy: rho-double tract vs. J-pouch double tract [Ｊ]. Dig Surg, 2000; 17(5)∶ 475.
  22. 22. 　Tomita R, Fujisaki S, Tanjoh K, et al. Studies on gastrointestinal hormone and jejunal interdigestive migrating motor complex in patients with or without early dumping syndrome after total gastrectomy with Roux-en-Y reconstruction for early gastric cancer [Ｊ]. Am J Surg, 2003; 185(4)∶ 354.
  23. 23. 　Meyer L, Meyer F, Dralle H, et al. Insufficiency risk of esophagojejunal anastomosis after total abdominal gastrectomy for gastric carcinoma [Ｊ]. Langenbecks Arch Surg, 2005; 390(6)∶ 510.
  24. 24. 　Zherlov G, Koshel A, Orlova Y, et al. New type of jejunal interposition method after gastrectomy [Ｊ]. World J Surg, 2006; 30(8)∶ 1475.
  25. 25. 　楊培民. 全胃切除術(shù)后兩種代胃術(shù)式的比較 [Ｊ]. 中華胃腸外科雜志， 2006； 9(1)∶ 23.
  26. 26. 　Rea T, Bartolacci M, Leombruni E, et al. Study of the antireflux action of the Roux-en-Y jejunal loop in reconstruction after gastrectomy and nutritional status in the follow-up [Ｊ]. Ann Ital Chir, 2005; 76(4)∶ 343.
  27. 27. 　Yumiba T, Kawahara H, Nishida T, et al. Jejunal pouch interposition with fundic-like plication after total gastrectomy [Ｊ]. Surg Today, 2005; 35(8)∶ 623.