新噴門切除術式(食道空腸β吻合兼胃瘻造設術)に関する研究 : 特に術後病態生理の検討を中心にして

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Radical surgical operation for carcinoma of the lower thoracic esophagus and of cardiac end of the stomach, has recently been carried out in relative ease. Various operative methods have been described in the literature, however, most of those techniques have some disadvantages due to either complexity of the anastomoses' methods or post-operative regurgitating esophagitis. This method that the author is describing, has been carried out in this clinic since 1962 based on a quite new idea. The first advantage of this technique is to perform a jejuno-jejunostomy in such a way to prevent a reverse flow of the bile into the esophago-jejunostomy site. When one performs a jejuno-jejunostomy following esophago-jejunostomy according to the method described by Billroth, a right angle incision was established on the proximol loop instead of a longitudinal onetherefore, the jejuno-jejunostomy is completed as a picture of end to side anastomosis. The second advantage is, when the cancerous lesion is not involving the antral portion of the stomach, to use this gastric antram intact using it as a pouch for gastrostomy. By doing this, one may be able to pursuade an early post-operative feeding through the gastrostomy and the intaken food will not wash through the esophago-jejunostomy. This particular method was carried out on 183 clinical cases with operative mortality of only 1.6%. This investigative work was carried out to prove several points of its superiority in postoperative pathophysiological status, in comparison with other methods that have currently used. By using matured mongolian dogs, in one group this β anastomoses were done and in another group a routine side-to-side jejuno-jejunostomies were carried out first. Total amount of bile that have flew into the esophago-jejunostomy site was measured and clearfied the fact that the bile was found less in the former group proving its superiority. Further-more, an opaque media was injected into the gastrostomy site in the clinical operated cases and status of the back flow into the esophago-jejunostomy site was also evaluated. Total amount of bile flow into the gastric or jejunal drainage tube which was inserted post-operatively was also meticulously measured and in both instances the β anastomoses were much better than routine jejuno-jejunostomy established in side-to-side manner. Aggressive post-operative feeding through the gastrostomy, improved the post-operative nutritional status of the patients considerably and maintainance of their electrite balance became much easier than other patients who had total gastrectomy by other methods. A marked decrease in postoperative anastomosis insufficiency and various other types of pulmonary complications by simply utilizing this method. In the follow up stage, absorption and digestion ability, body weight and blood study were carefully performed revealing much better results than other previous operative methods. It is therefore concluded that this gastric antrum left intact seems to maintain a better nutritional and physical condition of the patients in their post-operative state. This operative method is not only very simple but also adequate enough to resonstract the gastrointestinal tract following a removal of the superior 3/4 of the stomach and it is applicable to various malignant and benigen lesions of the stomach.
千葉大学の論文
1965-03-28

新噴門切除術式(食道空腸β吻合兼胃瘻造設術)に関する研究 : 特に術後病態生理の検討を中心にして

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