摘要
目的观察贲门癌术后残胃功能变化，以探讨改善贲门癌患者术后的生活质量。方法对１７例贲门癌患者行近端胃次全切除附加幽门括约肌“捏断”术。术中在幽门括约肌“捏断”前后分别行幽门测压。术后第５天抽取胃液测定总胆汁酸含量，第１８～２０天行放射性核素胃排空检查，并与单纯近端胃次全切除患者及正常人进行对比观察。结果（１）近端胃次全切除后，幽门收缩压高于正常（Ｐ＜００１），幽门括约肌“捏断”后低于正常（Ｐ＜００１）；而幽门静息压在幽门括约肌“捏断”前和“捏断”后，均与正常人差异无显著意义（Ｐ均＞００５）。（２）胃液中总胆汁酸含量三组间差异无显著意义（Ｐ均＞００５）。（３）胃次全切除加幽门括约肌“捏断”组半量胃排空时间与正常对照组差异无显著意义（Ｐ＜００５），而单纯胃次全切除组明显延长（Ｐ＜００５）。结论贲门癌行近端胃次全切除术后，幽门压力升高，残胃蠕动减弱，排空延缓。附加幽门括约肌“捏断”能有效降低幽门压力，促进残胃排空，改善术后症状，是一种值得推荐的手术方法。
Objective To evaluate the function of the remnant stomach after proximal subtotal gastrectomy for cardiac cancer and to improve the life quality of post surgical patients. Methods 17 patients with cardiac cancer underwent proximal subtotal gastrectomy combined with disconnection of pyloric sphincter (PSG+DPS) by finger pressing.Intraoperative pyloric manomitric studies were performed in the 17 patients before and after DPS.Five subjects who underwent laparotomy for nonesophagogastric reasons was taken as controls.Total bile acids (TBA) in gastric juice was tested in the 17 patients at 5th postoperative day, and radionuclide gastric emptying was also studied from the 18th to 20st postoperative day. Results Both pyloric resting pressure and pyloric contracting pressure were significantly decreased after DPS ( P >0 01). In comparison with normal subjects, PCP was increased before DPS ( P >0 01) and decreased after the procedure ( P <0 05). However, PRP did not show significant differences before ( P >0 05) and after ( P >0 05) DPS.There were no significant differences regarding TBA content in gastric juice in PSG+DPS group, PSG group, and normal subjects ( P >0 05).The time required for the stomach to empty half of its radioactive contents (T1/2) was longer in the patients having PSG only than those undergoing PSG+DPS ( P <0.01) and normal controls ( P <0.05). However, there were no significant differences regarding T1/2 between the patients with PSG+DPS and normal controls ( P >0 05). Conclusions The emptying of remnant stomach after subtotal gastrectomy for cardiac cancer is delayed because of the increase of emptyingresistance and decrease of peristalsis. PSG combined with DPS not only improves gastric emptying, but also prevents duodenogastric reflux. Consequently, postoperative life quality of the patients with cardiac cancer can be effectively improved.
出处
《中华外科杂志》
CAS
CSCD
北大核心
1999年第2期82-85,共4页
Chinese Journal of Surgery
