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目的为给予全胃切除术后的患者选择一种相对最佳的重建方式,以期减轻术后消化功能紊乱的症状、改善生活质量。方法以任意词“胃癌”、“全胃切除术后”、“消化道重建”等,通过中国知网、Pubmed、Medline等数据库检索、收集国内外相关的近4年文献。结果总共检索出文献42篇,其中临床研究18篇,前瞻性研究12篇,综述8篇,基础性研究4篇。结论 (1)RY是全胃切除术后最常使用的重建方式,空肠间置及双通道重建效果较RY更佳,但其操作相对复杂、手术时间较长。(2)对于能根治性切除且可能长期生存的患者,可尽量选择保持十二指肠通道连续的“贮袋”代胃重建方式,晚期胃癌患者可选择尽量简单的重建方式或者给予单纯的短路手术;(3)各种“贮袋”代胃重建可以改善病人术后早期的营养状态,维持体重,提高生活质量。而对于是否保留十二指肠通道的连续性仍有争议。
The purpose is to select a relatively optimal reconstruction method for patients after total gastrectomy in order to reduce the symptoms of postoperative digestive dysfunction and improve the quality of life. METHODS: Using the words “gastric cancer”, “after total gastrectomy”, “reconstruction of digestive tract”, etc., through the databases of China Knowledge Network, Pubmed, Medline, etc. . Results A total of 42 literatures were retrieved, including 18 clinical studies, 12 prospective studies, 8 review articles, and 4 basic research articles. Conclusions (1) RY is the most commonly used reconstruction method after total gastrectomy. The effect of jejunal and dual-channel reconstruction is better than RY, but its operation is relatively complicated and the operation time is longer. (2) For patients who are able to undergo radical resection and may have long-term survival, they may choose to maintain a continuous duodenal approach with a “pouch” or “stomach reconstruction” approach. Patients with advanced gastric cancer may choose to rebuild as simple as possible or simply Short-circuit surgery; (3) various “pouch” replacement of the stomach can improve early postoperative nutritional status of patients, maintain weight and improve quality of life. There is still controversy as to whether or not to retain the continuity of the duodenal passage.