全胃切除术后发生Roux-en-Y滞留综合征危险因素分析
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摘要
目的探讨全胃切除术后发生Roux-en-Y滞留综合征(RYS)风险因素及防范措施。方法回顾性分析2012年7月至2016年7月潍坊医学院附属益都中心医院行全胃切除术76例患者的临床资料,通过单因素和多因素Logistic回归模型分析全胃切除术后发生RYS的危险因素。结果 76例患者男45例,女31例,年龄中位数为59.5岁。术后RYS的发病率为10.53%(8/76)。单因素分析显示,结肠前吻合和上升肠襻长度≥45 cm,与全胃切除术后RYS发生有关(χ~2=7.578、6.887,P=0.006、0.009)。多因素Logistic回归分析显示,上升肠襻长度≥45 cm是全胃切除术后发生RYS的独立危险因素(OR=11.625,95%CI=1.286～105.052,P=0.029)。结论全胃切除术中上升肠襻长度尽量保留40 cm左右,以降低RYS发生率。
Objective To investigate the risk factors and preventive measures of Roux-en-Y stasis syndrome(RYS) after total gastrectomy. Methods Clinical data of seventy-six patients undergoing total gastrectomy in Yidu Central Hospital Affiliated to Weifang Medical University between July 2012 and July2016 were analyzed retrospectively. Univariate and multivariate analysis were applied to evaluate factors in?uencing RYS after total gastrectomy using log-rank and Logistic regression model. Results There were45 males and 31 females with a median age of 59.5 years. The incidence of RYS after total gastrectomy was limb measured more than 45 cm were signi?cantly associated with RYS after total gastrectomy(χ~2=7.578,6.887; P=0.006,0.009).independent P=0.029). Conclusion It that enteroenterostomy should be about 40 cm in order to reduce the incidence of RYS.
Objective To investigate the risk factors and preventive measures of Roux-en-Y stasis syndrome(RYS) after total gastrectomy. Methods Clinical data of seventy-six patients undergoing total gastrectomy in Yidu Central Hospital Affiliated to Weifang Medical University between July 2012 and July2016 were analyzed retrospectively. Univariate and multivariate analysis were applied to evaluate factors in?uencing RYS after total gastrectomy using log-rank and Logistic regression model. Results There were45 males and 31 females with a median age of 59.5 years. The incidence of RYS after total gastrectomy was limb measured more than 45 cm were signi?cantly associated with RYS after total gastrectomy(χ~2=7.578,6.887; P=0.006,0.009).independent P=0.029). Conclusion It that enteroenterostomy should be about 40 cm in order to reduce the incidence of RYS.
引文
[1]余佩武,赵永亮.全腹腔镜全胃切除术消化道重建方式选择及技术要点[J].中国实用外科杂志,2016,36(9):942-945.
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[4]Otsuka R,Natsume T,Maruyama T,et al.Antecolic reconstruction is a predictor of the occurrence of roux stasis syndrome after distal gastrectomy[J].J Gastrointest Surg,2015,19(5):821-824.
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[7]Ma JJ,Zang L,Yang A,et al.A modified uncut Roux-en-Yanastomosis in totally laparoscopic distal gastrectomy:preliminary results and initial experience[J].Surg Endosc,2017,31(11):4749-4755.
[8]Hinder RA,Esser J,DeMeester TR.Management of gastric emptying disorders following the Roux-en-Y procedure[J].Surgery,1988,104(4):765-772.
[9]胡祥.胃切除术后消化道重建方式的选择[J].中华消化外科杂志,2015,14(11):898-901.
[2]Britton JP,Johnston D,Ward DC,et al.Gastric emptying and clinical outcome after Roux-en-Y diversion[J].Br J Surg,1987,74(10):900-904.
[3]张水龙,侯霞,毕小刚,等.贲门癌根治性全胃切除术后Roux-en-Y滞留综合征的研究[J].实用癌症杂志,2014,29(4):466-468.
[4]Otsuka R,Natsume T,Maruyama T,et al.Antecolic reconstruction is a predictor of the occurrence of roux stasis syndrome after distal gastrectomy[J].J Gastrointest Surg,2015,19(5):821-824.
[5]Miedema BW,Kelly KA.The Roux operation for postgastrectomy syndromes[J].Am J Surg,1991,161(2):256-261.
[6]Noh SM,Bae JS,Jeong HY,et al.Roux stasis syndrome in conventional Roux-en-Y gastrojejunostomy and uncut Roux-en-Ygastrojejunostomy after subtotal gastrectmy[J].Korean Gastric Cancer Assoc,2001,1(1):38-43.
[7]Ma JJ,Zang L,Yang A,et al.A modified uncut Roux-en-Yanastomosis in totally laparoscopic distal gastrectomy:preliminary results and initial experience[J].Surg Endosc,2017,31(11):4749-4755.
[8]Hinder RA,Esser J,DeMeester TR.Management of gastric emptying disorders following the Roux-en-Y procedure[J].Surgery,1988,104(4):765-772.
[9]胡祥.胃切除术后消化道重建方式的选择[J].中华消化外科杂志,2015,14(11):898-901.