胃空肠储袋侧-端吻合术(附66例报告)

Gastric Jejunum-Pouch Side-End Anastomosis : 66 Case Reports

摘要: 目的：介绍一种胃空肠吻合的新术式——胃空肠储袋侧-端吻合术。方法：在传统Billroth II式胃空肠吻合术基础上，成都军区总医院胃肠外科设计了在输入袢与输出袢交汇处增加空肠侧-侧吻合形成空肠储袋，其顶端与胃后壁吻合的新术式——胃空肠储袋侧-端吻合术。本文回顾性分析自2012年3月至2014年2月实施66例胃空肠储袋侧-端吻合术患者的临床资料。其中，51例实施手辅助腹腔镜远端胃癌D2根治术，8例不能切除胃癌行上腹部正中小探查切口、胃空肠储袋侧-端吻合术+小弯侧血管神经结扎切断术，7例良性幽门梗阻行手辅助腹腔镜高选择性迷走神经切断+远端半胃切除术。结果：手术切口6.5~8 cm(平均7.1 cm)，手术时间70~205 min(平均165.6 min)，术中出血量50~300 ml(平均174.5 ml)，肛门排气时间2~5天(平均3.7天)，术后饮食恢复时间3~7天(平均4.6天)，术后住院时间6~13天(8.3天)。术后2 h腹腔血管出血1例，再手术止血治愈。无胃瘫，无围手术期死亡。随访1~12个月，患者自述无反酸和反流性食管炎症状出现，胃镜复查见轻度吻合口炎3例，胃内胆汁返流明显者2例。结论：胃空肠储袋侧-端吻合术，操作简单，手术安全，且预防反流性胃炎的临床效果良好；空肠储袋具有贮存和收集胆汁等消化液的功能，有利于患者术后早期恢复。

Abstract: Objectives: To introduce a simple new operation of gastrojejunostomy, gastric jejunum-pouch side-end anastomosis was to be reported. Method: Gastric jejunum-pouch side-end anastomosis, which was designed by the gastrointestinal ward of the Chengdu Army General Hospital, was jejunal pouch with the stomach wall anastomosis, such as Billroth II gastrojejunostomy. The clinical data of 66 cases of gastric jejunum-pouch anastomosis were analyzed retrospectively from March 2012 to February 2014. Among them, 51 cases are hand assisted laparoscopic D2 radical distal gastrectmy; 8 cases on small and medium-sized probe incision and gastric jejunum-pouch anastomosis, plus the little side vascular nerve ligation amputation; 7 cases on laparoscopic highly selective vagus nerve cut plus distal gastrectomy. Results: Incision length 6.5 - 8 cm (7.1 cm on average), operation time 70 - 205 min (mean 165.6 min), intraoperative blood loss 50 - 300 ml (174.5 ml), anal exhaust time 2 - 5 days (mean 3.7 days), postoperative diet recovery time 3 - 7 days (mean 4.6 days), postoperative hospital stay 6 - 13 days (mean 8.3 days). Abdominal vascular hemorrhage after 2 h in 1 case was cured by surgical hemostasis. In all 66 cases, there was no gastric parplysis, and no perioperative death. During 1 - 12 months after operation, no reflux and reflux esophageal inflammation shape were complained of by patients, but the light anastomotic inflammation in 3 cases and gastric bile reflux significantly in 2 cases were checked out by gastroscope review. Conclusions: Gastric jejunum-pouch side-end anastomosis was a simple and safe operation; and the clinical effect to prevent reflux gastritis was good. Jejunum-pouch to be of the function of storage and collection of the digestive juice, such as bile and ect., might be beneficial to patients for early postoperative recovery.