目的探讨如何降低胰十二指肠切除术后胰空肠吻合口漏的发生。方法采用胰管空肠吻合胰腺残端套入法行胰肠吻合，按胰、胆、胃顺序与空肠重建消化道。结果27例胰十二指肠切除术中，手术并发症7例（25.93%），其中应激性溃疡出血3例，胃排空延迟2例，腹腔及腹壁创口感染各1例，均经非手术治愈。全组无围手术期死亡，亦无一例发生胰瘘。结论胰瘘的发生同术式和操作技术密切相关，亦与吻合口部位血供和张力以及吻合口远端通畅与否有关。本术式增加了胰空肠吻合的严密性，对预防胰瘘的发生起到了积极的效果，且操作简便，易于掌握，效果可靠。
目的总结降低胰十二指肠切除术后胰空肠吻合口漏发病率的经验体会。 方法切除胰头后，将胰腺残端游离2.5～3.0 cm，利用红色石蕊试纸遇碱性胰液变蓝的特性，帮助寻找胰腺断面被横断的小导管，丝线贯穿缝扎。将空肠袢断端2.0～2.5 cm浆肌层剥除后施行套叠式胰空肠端端吻合，距浆肌层游离缘1.0～1.5 cm 处空肠上下壁各缝1针固定，最后用纤维蛋白胶封闭吻合口。结果47例患者中无一例发生胰空肠吻合口漏。结论该法操作较简便，适用于胰腺残端各种情况的处理。
Objective To explore the optimal technique for digestive tract reconstruction of proximal gastrectomy. Methods Fifty-nine patients who underwent proximal subtotal gastrectomy during June 2004 and January 2007 were analyzed retrospectively. All patients were divided into 2 groups according to the styles of reconstruction: one group with gastroesophagostomy (GE group) and the other with accommodation double tract digestive reconstruction of jejunal interposition (GIE group). The reconstruction of GIE group was to interposite a continuous 35 cm jejunum between the gastric stump and the oesophagus, which detail had been reported in our previous literature. The quality of life in 2 groups were evaluated and compared. Results No patient died and there was no anastomotic leakage, dumping syndrome and moderate or severe anemia occurred during perioperative period. There was no significant difference of the following indexes of nutrition between 2 groups 1 month and 6 months after operation: the value of weight, RBC, Hb, Alb, PNI and the indexes versus the preoperative ones (Pgt;0.05), for the exception of the indexes of RBC (P=0.006), Hb (P=0.001) in 1 month after operation versus the preoperative ones. The abdominal and the reflux esophagitis symptoms in GIE group were milder than those in GE group (Plt;0.001). The Visick scoring: most of the GIE group were gradeⅡ (74.2%), and grade Ⅲ (64.3%) in the GE group. There was no delay of the first time of adjuvant chemotherapy in GIE group (Pgt;0.05), and the surgical time was (0.35±0.13) h more than that of GE group (P=0.01). Conclusion The accommodation double tract digestive reconstruction of jejunal interposition for proximal subtotal gastrectomy may be safe and feasible by decreasing residual cancer cells and improving the quality of life of patients with proximal gastric carcinoma who underwent such surgical procedure.
ObjectiveTo explore feasibility and safety of π-shaped esophagojejunal anastomosis in totally laparoscopic total gastrectomy (TLTG).MethodThe clinical data of 20 patients who underwent TLTG, admitted in the Affiliated Hospital of Xuzhou Medical University from January 2018 to December 2018 were retrospectively analyzed.ResultsTLTG with π-shaped esophagojejunal anastomosis was successfully carried out in all 20 patients. The operative time was (236.0±55.5) min, the π-shaped esophagojejunal anastomosis time was (25.7±4.8) min, the intraoperative blood loss was (192.0±148.9) mL, the operative incision length was (3.7±0.8) cm. The postoperative pain score was 2.4±1.1, the first flatus time was (3.1±0.9) d, the first postoperative ambulation time was (1.8±0.7) d, the removal time of nasoenteral nutrution tube was (7.4±2.4) d, the liquid diet time was (6.2±1.4) d, the removal time of intraoabdominal drainage tube was (7.8±2.8) d, the postoperative hospital stay was (10.8±3.0) d. There was no death related to the anastomosis in all patients. Two patients developed a little pleural effusion and 1 patient developed lymphatic leakage were cured with conservative treatment. One patient with intraabdominal encapsulated effusion was cured by puncture and drainage treating. There was no postive incisal margin. The length of upper segment of resection form gastric cancer was (2.3±1.7) cm, the maximum tumor diameter was (4.9±2.8) cm, the number of dissected lymph nodes was 27.9±5.6. All patients were followed up 3–15 months. Eight patients underwent endoscopic examination had no obvious anastomosis stenosis and esophageal reflux. Two patients died of tumor recurrence and metastasis witnin one year after operation, and the rest had disease-free survival until the end of follow-up.ConclusionFrom preliminary results of limited cases in this study, π-shaped esophagojejunal anastomosis in TLTG is a technically safe and feasible surgical procedure in treatment of gastric cancer.
目的 探讨全胃切除术后消化道重建方式的选择。 方法 我院2001年6月至2006年6月期间对182例胃癌患者全胃切除术后分别行空肠ρ袢代胃术(PRY)69例和非离断式食管空肠改良Roux-en-Y吻合术(URY)113例。 分析手术时间、术后进食情况、消化道症状及营养状况的差异。结果 非离断式食管空肠改良Roux-en-Y吻合术手术时间短于空肠ρ袢代胃术，且无Roux潴留综合征（RSS）发生。 2种术式术后患者营养状况并无明显差异。结论 非离断式食管空肠改良Roux-en-Y吻合术操作简单、并发症少、术后恢复良好，可以推荐作为全胃切除术后的消化道重建术式。
Objective To investigate the new method of pancreaticoenterostomy and decrease the probability of complications like pancreatic fistula etc. Methods By using the absorbable bandage and ear-brain glue, modified sutureless pancreaticoenteromy was made in 10 swines. Experimental data includes： routine analysis of blood, levels of amylase in blood and abdominal drainage and lipase in blood and abdominal drainage. The tissues in anastomosis were taken for pathology examination in 1 month after operation. Results The average operative time was （35±10） min.Nine of ten animals had no pancreatic fistula and survived. The levels of amylase and lipase in abdominal drainage were both normal. One swine had a evident abdominal distensile on 2 days after operation, the level of amylase was 10 000u/L,then died on 10 days after operation. Pancreatic fistula and infection were found because of the loss of stent in pancreatic duct. Conclusions Comparison with traditional operation, the modified sutureless pancreaticoenteromy can also control the probability of pancreatic fistula. And this method can be hoped to be one of the routine operations of pancreaticoenterostomy because of its simplicity and practicality.
目的 探讨输入袢空肠结扎术在胆肠和胰肠吻合中的效果。 方法 我院2006年2月至2008年3月期间共收治43例需行胆肠及胰肠吻合的患者，分别行输入袢结扎的间置空肠吻合术（观察组，n=25）和经典的Roux-en-Y吻合术（对照组，n=18），观察2组患者手术时间、住院时间、肠功能恢复时间、返流性胆管炎、胆管积气及并发症发生情况。 结果 与经典的Roux-en-Y吻合术相比，输入袢结扎的间置空肠吻合术患者消化道重建时间、术后住院时间及肠功能恢复时间明显缩短,返流性胆管炎及胆管积气发生例数均显著减少，差异有统计学意义(Plt;0.05)。对照组2例患者出现切口感染； 观察组1例切口感染，1例肺部感染，均经对症治疗后痊愈。 结论 输入袢结扎的间置空肠吻合术操作简单、术后恢复快、并发症少，在上腹部消化道重建中有一定的应用价值。