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本文总结我院近几年来因胃癌行胃部分切除不能行毕Ⅰ式吻合而被迫行毕Ⅱ式吻合的病例,分单纯毕Ⅱ式吻合和毕Ⅱ式吻合加braun吻合两组进行对照观察。本组病人共31例,具体手术方法是在胃癌切除毕Ⅱ式肠吻合后在输入一输出袢间行侧一侧吻合(即braun吻合),尽量靠近屈氏韧带。其中毕Ⅱ式结肠前吻合加braun吻合8例,为Ⅰ组,单纯毕Ⅱ式结肠前吻合:3例为Ⅱ组。结果表明:①吻合口瘘,Ⅰ组无0/8;Ⅱ组2例(2/3);均为十二指肠残端瘘。②吻合口梗阻,Ⅰ组无(0/8);Ⅱ组3例(3/23);均有腹胀,呕吐症状,并经稀钡造影证实。9输入袢梗阻,Ⅰ组无(0/8),Ⅱ组1例(1/23);为拔除胃管后出现左上腹胀痛、呕吐,钡剂造影为吻合口狭窄所致。上述2例十二指残端瘘者也应考虑有输入袢梗阻。④胆汁返流性胃炎,Ⅰ组1/4,Ⅱ组11/11,均行胃镜证实有胆汁返流和萎缩性胃炎改变。③倾倒综合症,两组均无。⑥暖内疝,两组均无。⑦残胃癌,Ⅰ组尚未发现,Ⅱ组1例术后5年发生残胃癌。结果显示,毕Ⅱ式吻合加braun吻合较单纯毕Ⅱ式吻合具有并发症少,后遗症少等优点,如可以明显减少吻合口痿,吻合口梗阻,输入袢梗阻,胆汁返流性胃炎和残胃癌的发生,而并未增加倾倒综合征和腹内疝的发生,且较残胃一空肠Roux-y吻合操作简便,据此可以认为胃癌切除毕Ⅱ式吻合后加行braun
This article summarizes the cases in our hospital in recent years due to partial resection of gastric cancer can not be completed by type I anastomosis was forced to complete II type of anastomosis, divided into a simple type II anastomosis and Bi II anastomosis and braun anastomosis were two groups of control observation. A total of 31 patients in this group of patients, the specific surgical method is in the gastral resection after type II intestinal anastomosis in the input side of the output side of the line between the side of the anastomosis (braun anastomosis), as close as possible to the flexor ligament. Among them, 8 patients with type II precolic anastomosis plus braun anastomosis were included in group I, and only type II precolonal anastomosis was performed: 3 patients were in group II. The results showed that: 1 Anastomotic fistula, group I did not 0/8; II group 2 cases (2/3); both duodenal stump fistula. 2 Anastomotic obstruction was observed in group I (0/8); in group II in 3 cases (3/23); both had abdominal distension and vomiting symptoms and were confirmed by dilute angiography. 9 input obstruction obstruction, group I no (0/8), II group 1 case (1/23); to remove the stomach tube after the emergence of left upper abdominal pain, vomiting, barium contrast caused by anastomotic stenosis. In the above two cases of 12-finger stumps, input obstruction should also be considered. 4 Bile reflux gastritis, group I, 1/4, group II, 11/11, all had gastroscopy confirmed bile reflux and atrophic gastritis. 3 Dumping syndrome, none of the two groups. 6 warm internal hemorrhoids, neither group. 7 Gastric stump cancer was not found in group I. One patient in group II had gastric stump cancer at 5 years after operation. The results showed that bi-analysis plus braun anastomosis had fewer complications and fewer sequelae than simple bis anastomosis, such as anastomotic leakage, anastomotic obstruction, input obstruction, bile reflux gastritis, and gastric stump cancer. The occurrence of the disease did not increase the occurrence of dumping syndrome and intra-abdominal hernia, and was simpler than the Roux-y anastomosis of the jejunum-jejunum. Therefore, it can be considered that after the resection of the gastric cancer, the type II anastomosis was performed.