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目的 分析胃癌行全胃切除后Ⅰ或Ⅱ型间置空肠代胃生理功能。方法 31例胃癌行全胃切除术 ,其中胃底贲门癌经胸腹联合切除 8例 ,行Ⅰ型间置空肠代胃吻合 3例 ,Ⅱ型间置空肠代胃 5例 ;胃体癌经腹切除者 2 3例 ,其中Ⅰ型吻合 13例 ,Ⅱ型 10例。结果 两组均无手术死亡率及吻合口瘘发生。术后 1个月至 6个月作钡餐检查 ,见间置空肠袢均呈不同程度的“囊袋”扩张。 30～ 6 0minⅠ型和Ⅱ型排空时间分别为 6 2 5 %和 6 6 7% ,80～ 12 0min内分别为 37 5 %和 33 3%。饮食恢复正常 ,血浆总蛋白 5 6～ 75g/L ,占 74 2 % (2 3/ 31) ,4 6～ 5 5g/L2 5 8% (8/ 31)。血红蛋白 110～ 16 0g/L占 38 7% (12 / 31) ,96～ 10 5g/L 6 1 3% (19/ 31)。体重比发病前减轻 3～5kg ,从事较轻的体力劳动者 9例。按Visik分级 ,全组患者生活质量达到Ⅱ～Ⅲ级之间。结论 临床II、Ⅲ期的胃上部癌应选择行全胃切除术 ,而全胃切除术后间置空肠Ⅰ型或Ⅱ型代胃能提高病人生活质量。
Objective To analyze the physiological function of jejunum on stomach after type Ⅰ or Ⅱ gastrectomy for gastric cancer. Methods Twenty-one cases of gastric cancer underwent total gastrectomy. Among them, 8 cases underwent combined thoracoabdominal and gastric cardia cancer resection, 3 cases underwent type I interstitial pneumoperitoneum and 5 cases with type II interstitial pneumoperitoneum. Gastric carcinoma Excision of 23 cases, including type Ⅰ anastomosis in 13 cases, type Ⅱ in 10 cases. Results There was no operative mortality and anastomotic leakage in both groups. Postoperative 1 month to 6 months for barium meal examination, see interstitial jejunum were showed varying degrees of “capsular bag” expansion. The emptying time of Type I and Type II was 6 2 5% and 6 6 7% respectively at 30 ~ 60 minutes, and was 37 5% and 33 3% respectively within 80 ~ 120 minutes. The diet returned to normal with a total plasma protein of 56-75 g / L, accounting for 74.2% (23/31) and 46-55 g / L2 58% (8/31). Hemoglobin 110 ~ 160g / L accounted for 38 7% (12/31), 96 ~ 105g / L 6 1 3% (19/31). Weight loss than before the onset of 3 ~ 5kg, engaged in the lighter manual 9 cases. By Visik grading, the quality of life of all patients reached grade Ⅱ ~ Ⅲ. Conclusions Total gastrectomy should be performed in patients with stage II and stage III upper gastric cancer. After the total gastrectomy, the type I or type II gastrointestinal compartment can improve the quality of life of patients.