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위암환자에서 위아전절제후 일차적 Roux-en-Y 위공장문합술후 위내 음식물 정체에 관한 임상적 연구
김건균(Keon Kyun Kim),최경현(Kyung Hyun Choi) 대한소화기학회 1994 대한소화기학회지 Vol.26 No.1
N/A It is well known that Roux-en-Y reconstruction is a good way to prevent duodenogastric re- flux after subtotal gastrectomy. Most surgeons do not prefer to operate because of the prob- lem of food retention. W e surveyed the incidence of food retention to the gastric carcinoma patients who had sub- total gastrectomy and reconstruction by Roux-en-Y method only during from August 1988 to July 1993 in 327 cases. We classified five groups according to the length of R-Y limb and su- ture method: Group I is 30cm R Y limb, Group II is 25cm R Y limb, Group III is Tanner 19 method, Group IV is 25cm R Y limb and Gambee stitches at posterior side of gastrojejejunostomy, Group V is 25cm R Y limb and Gambee stitches at anterior and posterior side of gastrojejunostomy. Food retention was assessed by gastroscope when they still staying at hospital and during follow up period. Degree of food retention was arbitrarily defined as following: Grade 1;reten- tion volume is 1 5ml, Grade 2;between Grade 1 and 3, Grade 3; retention volume is about one half of the volume of gastrojejunal pouch, Grade 4;only a part of gastrojejunal pouch is visible, Grade 5;no part of gastrojejunal pouch is visible. We could perform this survey only 278 pa- tients out of 327 because of postoperative death or missing the follow up. Grade 1, 2, 3, 4 and 5 was 69, 26, 1 1, 4 and 8 cases. The groups showing higher retention including Grade 3, 4 and 5 was about 8.3%(23cases) and improved to 7.2%(20cases) after 3 months. There was no case of reoperation because of food retention but sorne of the problems could be managed by drugs. Therefore, we conclusively suggest that Roux-en-Y reconstruction after subtotal gastrectomy for the gastric cancer patients could be used safely.(Korean J Gastroentero11994; 26: 83 89)
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