Total gastrektomilerden sonra uygulanan rekonstrüksiyon metodlarının multifaktöriyel analizi
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Dosyalar
Tarih
2010
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Cilt Başlığı
Yayıncı
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Total gastrektomi gastrik kanserlerde ve lenfomalarda, akut mukozal eroziv lezyonlarda, Zollinger-Ellison sendromunda veya ciddi travmatik yaralanmalarda kimi zaman uygulanabilmektedir. Bu çalıflmada amaç total gastrektomi sonrası uygulanan pofllu ve poflsuz rekonstrüksiyon yöntemlerinin postoperatif semptomatoloji ve nütrisyon açısından irdelenmesidir. Yöntemler: Bu retrospektif çalıflma SSK Ankara Eğitim Hastanesi 2.Genel Cerrahi kliniğinde mide tümörü nedeniyle total gastrektomi yapılan, lokal nüksü ve metastazı olmayan 31 hasta üzerinde yapıldı. Bu hastalara uygulanan 6 farklı rekonstrüksiyon tipi, yafl, cinsiyet, tümör lokalizasyonu, tümörün histopatolojik tipi ve postoperatif komplikasyonlar açısından incelendi. Tüm olgulara üst G‹S endoskopisi ile özefagustan bir ve jejunumdan iki adet biyopsi alınarak geç dönem morfolojik ve mikrobiyolojik değiflimler arafltırıldı. Postoperatif kilo değişimi, dumping semptomları, reflü özefajit, sıvı/katı gıda disfajisi, erken doyma hissi, postprandial ağrı, diyare ve anoreksi sorgulandı. Bulgular: Hastaların 18’i erkek, 13’ü kadındı. En genç hasta 33 yaşında, en yaşlı hasta ise 69 yaşında idi. Ortalama yaş 55.3 olarak saptandı. 22 olguya poşsuz, 9 olguya poşlu rekonstrüksiyon yapıldığı saptandı. Erken doyma, postprandial ağrı, dumping semptomları, anemi ve diyare en sık poşsuz rekonstrüksiyonlarda saptandı. Jejunal bakteriyel kolonizasyon oranı her iki grupta benzer bulundu. Reflü özefajit en sık omega özefagojejunostomi (ÖJ)'de, en az Roux-en-Y, Tooley ve Tanner 19 ÖJ’de saptandı. Sonuç: Total gastrektomiden sonra poşlu rekonstrüksiyon yöntemleri postoperatif erken ve geç dönemdeki avantajları nedeniyle hala tercih edilebilir niteliktedir. (Haseki Tıp Bülteni 2010; 48:126-31)
Aim: The aim of this study was to evaluate the reconstruction methods applied after total gastrectomy in terms of postoperative symptomology and nutrition. Methods: This retrospective study was conducted on 31 patients who underwent total gastrectomy due to gastric cancer in 2. Clinic of General Surgery, SSK Ankara Training Hospital. 6 different reconstruction methods were used and analyzed in terms of age, sex and postoperative complications. One from esophagus and two biopsy specimens from jejunum were taken through upper gastrointestinal endoscopy from all cases, and late period morphological and microbiological changes were examined. Postoperative weight change, dumping symptoms, reflux esophagitis, solid/liquid dysphagia, early satiety, postprandial pain, diarrhea and anorexia were assessed. Results: Of 31 patients,18 were males and 13 females; the youngest one was 33 years old, while the oldest- 69 years old. It was found that reconstruction without pouch was performed in 22 cases and with pouch in 9 cases. Early satiety, postprandial pain, dumping symptoms, diarrhea and anemia were found most commonly in cases with reconstruction without pouch. The rate of bacterial colonization of the jejunal mucosa was identical in both groups. Reflux esophagitis was most commonly seen in omega esophagojejunostomy (EJ), while the least-in Roux-en-Y, Tooley and Tanner 19 EJ. Conclusion: Reconstruction with pouch performed after total gastrectomy is still a preferable method. (The Medical Bulletin of Haseki 2010; 48:126-31)
Aim: The aim of this study was to evaluate the reconstruction methods applied after total gastrectomy in terms of postoperative symptomology and nutrition. Methods: This retrospective study was conducted on 31 patients who underwent total gastrectomy due to gastric cancer in 2. Clinic of General Surgery, SSK Ankara Training Hospital. 6 different reconstruction methods were used and analyzed in terms of age, sex and postoperative complications. One from esophagus and two biopsy specimens from jejunum were taken through upper gastrointestinal endoscopy from all cases, and late period morphological and microbiological changes were examined. Postoperative weight change, dumping symptoms, reflux esophagitis, solid/liquid dysphagia, early satiety, postprandial pain, diarrhea and anorexia were assessed. Results: Of 31 patients,18 were males and 13 females; the youngest one was 33 years old, while the oldest- 69 years old. It was found that reconstruction without pouch was performed in 22 cases and with pouch in 9 cases. Early satiety, postprandial pain, dumping symptoms, diarrhea and anemia were found most commonly in cases with reconstruction without pouch. The rate of bacterial colonization of the jejunal mucosa was identical in both groups. Reflux esophagitis was most commonly seen in omega esophagojejunostomy (EJ), while the least-in Roux-en-Y, Tooley and Tanner 19 EJ. Conclusion: Reconstruction with pouch performed after total gastrectomy is still a preferable method. (The Medical Bulletin of Haseki 2010; 48:126-31)
Açıklama
Anahtar Kelimeler
Total Gastrektomi, Özefagojejunostomi, Reflü Özefajit, Dumping Sendromu, Total Gastrectomy, Esophagojejunostomy, Reflux Esophagitis, Dumping Syndrome
Kaynak
Haseki Tıp Bülteni
WoS Q Değeri
Scopus Q Değeri
Cilt
48
Sayı
4
