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自1981年2月至1991年3月,作者对29例(男15例,女14例)胃恶性肿瘤病人施行全胃切除食管空肠Roux-Y吻合空肠三腔代胃术。病人年龄26～68岁(平均48.2岁)。肿瘤位于胃体和/或体窦部14例,胃底和/或底体部9例,胃底贲门部4例,全胃2例。病理诊断;胃未分化腺癌3例,低分化腺癌16例,高分化腺癌7例,恶性淋巴瘤2例,平滑肌肉瘤1例。治疗结果表明多数病人恢复迅速,但发生膈下脓肿4例,胸部感染5例,腹部切口裂开1例。随访结果29例中22例已死亡,术后存活6～8个月7例,12～14个月14例,29个月1例。7例仍存活,其中3例为术后10～16个月,2例为25个月,1例为7年和1例存活11年。我们认为全胃切除食管空肠Roux-Y吻合空肠三腔代胃术具有以下优点:①宽大的代胃袋能贮存和吸收食物,②食物与胆胰液可在代胃袋内混合,有助消化和吸收,③手术不太复杂,④术后无返流性食管炎、倾倒综合征、腹泻等后遗症。
From February 1981 to March 1991, the authors performed a total gastrectomy with Roux-Y gastrojejunostomy and three-chamber gastrostomy in 29 patients (15 males and 14 females) with gastric malignancy. The patient’s age ranged from 26 to 68 years (average 48.2 years). The tumors were located in 14 cases of the corpus and/or sinus, 9 cases of fundus and/or bottom body, 4 cases of fundus, 2 cases of total stomach. Pathological diagnosis; 3 cases of gastric undifferentiated adenocarcinoma, 16 cases of poorly differentiated adenocarcinoma, 7 cases of well-differentiated adenocarcinoma, 2 cases of malignant lymphoma, and 1 case of leiomyosarcoma. The results of the treatment showed that most of the patients recovered rapidly, but 4 cases had subphrenic abscesses, 5 cases had chest infections, and 1 case had abdominal incisions. Follow-up results showed that 22 cases died in 29 cases, and survived 6 to 8 months in 7 cases, 14 cases in 12 to 14 months, and 1 case in 29 months. Seven patients were still alive. Three of them were postoperative 10 to 16 months, 2 were 25 months, 1 was 7 years, and 1 was 11 years old. We believe that the total gastrectomy Roux-Y anastomosis with jejunum three-cavity gastroplasty has the following advantages: (1) A large generation of gastroenterology bags can store and absorb food; (2) Food and biliary and pancreatic juice can be mixed in the stomach replacement bag to help digestion and absorption. 3 Surgery is not complicated, 4 There is no sequelae such as reflux esophagitis, dumping syndrome, and diarrhea.