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目的 探讨胃癌患者行全胃切除的适应证 ,合理手术入路的选择及术后消化道的重建方式。方法 复习经腹全胃切除术的 170例胃癌患者的临床资料。结果 根治性全胃切除 13 2例 ,姑息性全胃切除 3 8例 ,联合脏器切除 18例。全胃切除后采用食管空肠Roux Y吻合重建消化道 110例 ,间置空肠法重建消化道 60例。食管空肠Roux Y吻合发生倾倒综合征 2 0例 ,返流性食管炎 6例 ,间置空肠法重建消化道无一例发生。结论 (1)胃癌尤其是胃底贲门癌采用经腹手术效果较好。 (2 )严格掌握手术适应证 ,采用全胃切除可提高胃癌患者的生存期及生存质量。 (3 )根治性全胃切除术后采用间置空肠重建消化道优于食管空肠Roux Y法
Objective To investigate the indications of total gastrectomy in patients with gastric cancer, the choice of reasonable surgical approach and the way of postoperative digestive tract reconstruction. Methods To review the clinical data of 170 patients with gastric cancer undergoing total gastrectomy. Results radical total gastrectomy in 132 cases, palliative total gastrectomy 38 cases, combined with organ resection in 18 cases. After total gastrectomy with esophageal Roux Y reconstruction 110 cases of gastrointestinal reconstruction, interspace jejunal reconstruction of the digestive tract in 60 cases. Esophageal jejunum Roux Y coincidence with dumping syndrome 20 cases, reflux esophagitis in 6 cases, indirect jejunal reconstruction of the digestive tract in no case occurred. Conclusions (1) Gastroesophageal carcinoma, especially gastric cardia and gastric cardia, have better effect on abdominal surgery. (2) Strict control of surgical indications, the use of total gastrectomy can improve the survival of patients with gastric cancer and quality of life. (3) The use of indirect jejunal reconstruction of the digestive tract after gastrectomy is better than the Roux Y method of esophageal jejunum