| 摘要: |
| 目的分析全胃切除术中非离断式Roux-en-Y吻合不同桥襻距离对反流性食管炎的影响，探讨降低反流性食管炎发生风险的最佳桥襻距离。方法回顾性选取行全胃切除术治疗的胃癌患者29例，术中均采用非离断式Roux-en-Y吻合重建消化道。根据术中吻合采用的桥襻距离，将患者分为40cm组、50cm组、60cm组。观察并比较3组患者手术时间、术中出血量、术后肛门恢复排气时间、术后进食时间及术后住院时间。患者随访6个月，分别评估并比较3组患者术前及术后6个月消化道功能、营养状况、酸反流计分，出院前及术后1、3、6个月食管下端胃镜评分。结果3组患者手术时间、术中出血量、术后肛门恢复排气时间、术后进食时间及术后住院时间比较均无统计学差异（均P＞0.05）。组内比较，3组患者术后6个月消化功能、营养状况均明显优于术前（均P＜0.05），酸反流计分明显低于术前（均P＜0.05），食管下端胃镜评分均明显低于出院前（均P＜0.05）。组间比较，术前3组患者消化道功能、营养状况、酸反流计分比较均无统计学差异（均P＞0.05），出院前3组患者食管下端胃镜评分比较亦无统计学差异（P＞0.05）；术后6个月40cm组患者消化功能、营养状况均明显优于50cm组及60cm组（均P＜0.05），酸反流计分、食管下端胃镜评分均明显低于50cm组及60cm组（均P＜0.05）。结论40cm是全胃切除术中非离断式Roux-en-Y吻合最佳桥襻距离，患者术后反流性食管炎发生风险相对较低。 |
| 关键词: 全胃切除术 非离断式 Roux-en-Y 吻合 桥襻距离 反流性食管炎 |
| DOI：10.12056/j.issn.1006-2785.2017.39.8.2017-172 |
| 分类号: |
| 基金项目:浙江省科技厅公益性技术应用研究计划社发项目（2017C33130） |
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| Relationship between reflux esophagitis and bridge loop distance in total gastrectomy with non-isolated Roux-en-Y reconstruction |
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WANG Fengyong, YE Zaiyuan, SUN Yuanshui, NI Haibin, WU Jinfeng, HU Qiang
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Tongde Hospital of Zhejiang Province
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| Abstract: |
| Objective To investigate the relationship between reflux esophagitis and bridge loop distance in total
gastrectomy with non-isolated Roux-en-Y reconstruction. Methods Twenty-nine patients with gastric cancer treated by total gastrectomy were retrospectively analyzed. The gastrointestinal tract was reconstructed with non-isolated Roux-en-Y correlation and the bridge distance of intraoperative anastomosis was 40cm, 50cm or 60cm, respectively. The operation time, intraoperative blood loss, postoperative anal recovery time, postoperative feeding time and postoperative hospital stay were observed and compared. The patients were followed up for 6 months. The gastrointestinal function, nutritional status and acid reflux score were evaluated before and 6 months after operation; the endoscopic esophageal endoscopy score was evaluated at discharge and 1, 3 and 6 months after operation. Results There were no significant differences in the operation time, intraoperative blood loss, postoperative anal recovery time, postoperative eating time and postoperative hospital stay (P ＞0.05) among 3 groups. The digestive function and nutritional status were significantly improved after operation in all groups (P＜0.05), the acid reflux score was significantly lower than that before operation (P ＜0.05), the endoscopic score were significantly lower than those before discharge (all P＜0.05). There were no significant differences in digestive function, nutritional status and acid reflux score among
three groups before operation (P ＞0.05), and no significant difference in endoscopic scores among three groups before and after discharge (P ＞0.05). In 40 cm group the digestive function and nutritional status were significantly better, and the endoscopy scores, acid reflux scores were significantly lower than those in 50 cm and 60 cm groups (all P＜0.05). Conclusion The 40 cm
may be the best bridge distance in total gastrectomy with non-isolated Roux-en-Y reconstruction, and the risk of postoperative reflux esophagitis is relatively low. |
| Key words: Total gastrectomy Non-isolated type Roux-en-Y anastomosis Bridge loop distance Reflux esophagitis |
