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目的探讨远端胃亚全切除后应用Roux袢空肠间置(j ejunal interposition with Rouxlimb,JI-Roux)重建消化道的临床价值。方法远端胃亚全切除术后JI-Roux术式重建21例和Roux-en-Y术式重建23例,比较两组患者术后营养状态、生活质量和Roux滞留综合征(Roux stasis syndrome,RSS)发生率等。结果两组患者无手术死亡,无严重术后并发症,JI-Roux组平均手术时间为(245.0±23.1)分钟,Roux-en-Y组为(218.0±19.2)分钟。JI-Roux组术后6个月、12个月饮食恢复情况明显优于Roux-en-Y组(P<0.05),X线钡餐检查结果比较,JI-Roux组胃及Roux袢的排空延迟、肠腔扩张和RSS发生率均较低(P<0.05);胃镜检查结果,两组患者胃黏膜阳性病变比较差异无统计学意义(P>0.05)。两组患者术后12个月平均体重均较术前下降,但JI-Roux组患者的体重下降幅度较小(P<0.05),且血浆白蛋白水平较高(P<0.05),Visick分级优于Roux-en-Y组(P<0.05)。结论远端胃亚全切除后JI-Roux重建术不仅能防止胆汁、胰液反流,有效预防RSS,而且部分食物能进入十二指肠,有助于食物消化、吸收,是远端胃亚全切除术后消化道重建较理想的术式。
Objective To investigate the clinical value of reconstruction of digestive tract with Roux 袢 jejunum interposition (JI-Roux) after distal subtotal gastrectomy. Methods Twenty-one patients underwent JI-Roux reconstruction after distal subtotal gastrectomy and 23 patients underwent Roux-en-Y surgical reconstruction. The nutritional status, quality of life and Roux stasis syndrome RSS) incidence and so on. Results There was no operative death and no serious postoperative complications in the two groups. The mean operative time was (245.0 ± 23.1) minutes in the JI-Roux group and (218.0 ± 19.2) minutes in the Roux-en-Y group. The postprandial 6-month and 12-month postprandial diet regimens in JI-Roux group were significantly better than those in Roux-en-Y group (P <0.05). The X-ray barium meal test results showed that the delayed gastric emptying and Roux 袢 emptying in JI-Roux group (P <0.05). Gastroscopy showed no significant difference in gastric mucosal lesions between the two groups (P> 0.05) .2. The average body weight at 12 months after operation in both groups decreased compared with that before operation. However, the weight loss in JI-Roux group was smaller (P <0.05), and the plasma albumin level was higher (P <0.05) In Roux-en-Y group (P <0.05). Conclusion JI-Roux reconstruction after distal subtotal gastrectomy not only prevents the reflux of bile and pancreatic juice, effectively prevents RSS, but also can enter part of the duodenum and helps digestion and absorption of food. After resection of the digestive tract reconstruction of the ideal operation.