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

目的　 探討近端胃癌根治術(shù)后合理的消化道重建方式。
方法 　回顧性總結(jié)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(xù)病例59例,依據(jù)重建方式分為2組： 胃食管側(cè)端吻合重建組(GE組)和調(diào)節(jié)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(zhǎng)35 cm的連續(xù)性間置空腸,對(duì)比分析2組術(shù)后患者生活質(zhì)量狀況。
結(jié)果 　全組病例無(wú)圍手術(shù)期死亡、吻合口漏、傾倒綜合征及中度以上貧血病例發(fā)生。術(shù)后1和6個(gè)月體重、RBC、Hb、Alb、PNI值以及其相對(duì)于術(shù)前的變化值〔術(shù)后1個(gè)月RBC(P=0.006)、Hb(P=0.001)相對(duì)于術(shù)前的變化值除外〕,GIE組和GE組間差異均無(wú)統(tǒng)計(jì)學(xué)意義(P gt;0.05)。GIE組術(shù)后腹部癥狀和反流性食管炎癥狀的Visick評(píng)分優(yōu)于GE組(P＜0.001): GIE組主要為Ⅱ級(jí)(74.2%),GE組主要為Ⅲ級(jí)(64.3%)。與GE組比較，GIE組術(shù)后并未延遲首次化療時(shí)間(P gt;0.05),手術(shù)時(shí)間延長(zhǎng)(0.35±0.13) h (P=0.01)。
結(jié)論 　調(diào)節(jié)型雙通道間置空腸消化道重建在近端胃次全切除術(shù)中是安全、可行的,有利于防止癌細(xì)胞殘留和改善近端胃癌根治術(shù)后患者生活質(zhì)量。

引用本文： 肖仕明,姜淮蕪,吳宸,歐榮冊(cè),陳進(jìn),肖琳. 根治性近端胃切除術(shù)后的兩種重建術(shù)式評(píng)價(jià). 中國(guó)普外基礎(chǔ)與臨床雜志, 2008, 15(9): 682-685. doi: 復(fù)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(jìn), 等. 全胃切除調(diào)節(jié)型雙通道間置空腸消化道重建 [Ｊ]. 中國(guó)普外基礎(chǔ)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(shù)后保留幽門(mén)環(huán)間置空腸重建消化道術(shù)式的應(yīng)用 [Ｊ]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2003; 10(5)∶497.
9. 　梁寒, 郝希山. 胃癌術(shù)式對(duì)患者術(shù)后營(yíng)養(yǎng)的影響 [Ｊ]. 中國(guó)腫瘤臨床, 2007; 34(12)∶716.
10. 　詹文華. 消化道重建： 循證醫(yī)學(xué)和全胃切除后消化道重建 [Ｊ]. 中國(guó)實(shí)用外科雜志, 2004; 24(9)∶514.
11. 　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(guó)普外基礎(chǔ)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(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(guó)普外基礎(chǔ)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. 1. 　Harder J, Opitz OG. Gastric cancer——risk factors and medical therapy [Ｊ]. Schweiz Rundsch Med Prax, 2006; 95(25-26)∶1021.
  2. 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. 3. 　Kretzschmar A, Schlag PM. Efficacy of current adjuvant and neoadjuvant therapeutic concepts in gastric cancer? [Ｊ]. Zentralbl Chir, 2006; 131(2)∶121.
  4. 4. 　Gonzalez RJ, Mansfield PF. Adjuvant and neoadjuvant therapy for gastric cancer [Ｊ]. Surg Clin North Am, 2005; 85(5)∶1033.
  5. 5. 　Menges M. Diagnosis, staging and therapy of gastric cancer [Ｊ]. Z Gastroenterol, 2004; 42(8)∶767.
  6. 6. 　Chadha MK, Kuvshinoff BW, Javle MM. Neoadjuvant therapy for gastric cancer [Ｊ]. Oncology (Williston Park), 2005; 19(9)∶1219.
  7. 7. 　肖仕明, 姜淮蕪, 陳進(jìn), 等. 全胃切除調(diào)節(jié)型雙通道間置空腸消化道重建 [Ｊ]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2008; 15(1)∶23.
  8. 8. 　張朝軍, 羅云生, 葛海燕, 等. 全胃切除術(shù)后保留幽門(mén)環(huán)間置空腸重建消化道術(shù)式的應(yīng)用 [Ｊ]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2003; 10(5)∶497.
  9. 9. 　梁寒, 郝希山. 胃癌術(shù)式對(duì)患者術(shù)后營(yíng)養(yǎng)的影響 [Ｊ]. 中國(guó)腫瘤臨床, 2007; 34(12)∶716.
  10. 10. 　詹文華. 消化道重建： 循證醫(yī)學(xué)和全胃切除后消化道重建 [Ｊ]. 中國(guó)實(shí)用外科雜志, 2004; 24(9)∶514.
  11. 11. 　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(guó)普外基礎(chǔ)與臨床雜志, 2006; 13(1)∶15.
  12. 12. 　Visick AH. Measured radical gastrectomy: review of 505 operations for peptic ulcer [Ｊ]. Lancet, 1948; 1〖KG-*3〗∶505.
  13. 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. 14. 　Leong T. Chemotherapy and radiotherapy in the management of gastric cancer [Ｊ]. Curr Opin Gastroenterol, 2005; 21(6)∶673.
  15. 15. 　Lim L, Michael M, Mann GB, et al. Adjuvant therapy in gastric cancer [Ｊ]. J Clin Oncol, 2005; 23(25)∶6220.
  16. 16. 　Berardi R, Scartozzi M, Romagnoli E, et al. Gastric cancer treatment: a systematic review [Ｊ]. Oncol Rep, 2004; 11(4)∶911.
  17. 17. 　Varadhachary G, Ajani JA. Preoperative and adjuvant therapies for upper gastrointestinal cancers [Ｊ]. Expert Rev Anticancer Ther, 2005; 5(4)∶719.
  18. 18. 　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(guó)普外基礎(chǔ)與臨床雜志, 2002; 9(3)∶151.
  19. 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. 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. 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. 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.