中国实用外科杂志

中国实用外科杂志

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晚期胃癌术中消化道重建方式选择及争议

徐泽宽，汪未知，徐    皓   

  1. 南京医科大学第一附属医院普通外科，江苏南京210029
  • 出版日期:2017-10-01 发布日期:2017-10-11

  • Online:2017-10-01 Published:2017-10-11

摘要：

晚期胃癌术中消化道重建方式的选择与手术的安全性以及病人的术后生活质量密切相关。对于姑息性远端胃切除术，推荐Billroth Ⅱ式+Braun吻合或Roux-en-Y吻合；对于全胃切除术后的消化道重建，首选Roux-en-Y吻合。对于无法行姑息性肿瘤切除术，且伴消化道梗阻的病人，可行胃空肠吻合或胃空肠吻合+Braun吻合。如病人身体情况无法耐受手术治疗，可考虑行内镜下支架植入术。此外，如肿瘤近贲门位置或存在广泛腹膜转移、小肠转移，应优先考虑胃造口术；如病人诊断为皮革胃、胃部肿瘤侵及全胃，应考虑行空肠造口。

关键词: 晚期胃癌, 消化道重建, 胃空肠吻合

Abstract:

Controversies and countermeasures on reconstruction of digestive tract during surgery for advanced gastric cancer        XU Ze-kuan，WANG Wei-zhi，XU Hao. Department of General Surgery, the First Affiliated Hospital of Nanjing Medical University，Nanjing 210029，China
Corresponding author：XU Ze-kuan，E-mail：xuzekuan@njmu.edu.cn
Abstract    The choice of digestive tract reconstruction in advanced gastric cancer is closely related to the safety of operations and the quality of postoperative life of patients. For palliative distal gastrectomy, Billroth Ⅱ + Braun anastomosis or Roux-en-Y anastomosis is recommended while Roux-en-Y anastomosis is recommended after total gastrectomy. For patients who are not suitable for palliative tumor resection and with digestive tract obstruction, gastrojejunostomy or gastrojejunostomy + Braun anastomosis is preferred. For patients who is not able to tolerate surgical treatments, endoscopic stent implantation may be under consideration. In addition, if tumor is located near cardia or the extensive peritoneal metastasis exists, priority should be given to gastrotomy. If the patient is diagnosed with linitis plastica or gastric cancer involving the entire stomach, the jejunostomy should be considered.

Key words: advanced gastric cancer, digestive tract reconstruction, gastrojejunostomy