用于胃良性病变：典型的胃大部切除术，变异：胃窦切除（图文演示）

20. Postop management
Postoperative management following a Billroth I anastomosis:
A drain is placed in the abdominal cavity near the anastomosis.
The nasogastric tube is placed by direct palpation opposite the anastomosis. It is maintained for 2 to 5 days at a low suction (less than 30 mm Hg) before retrieval.
Evaluation of the anastomosis (esogastroduodenal gastrograffin swallow) is recommended before resuming PO intake.
The drain is removed on the fifth postoperative day.

Postoperative management following a Billroth II anastomosis:
Billroth II anastomosis is a particularly safe procedure; anastomotic failures are rare.

Danger:
“Marginal ulcer” associated with hematemesis, melena and possible transitory anemia may be observed after mechanical anastomosis. In some cases, it is necessary to re-operate to complete hemostasis of the resection line (Kyzer et al., 1997).

Conclusion
Today, gastrectomies for benign lesions are rarely performed. Some authors contest their utility. (Witte, 1997; Witte, 1995).
Yet they remain useful for the treatment of gastric ulcers (Lacaine, 1996), especially in areas where the availability of medical treatment is inconsistent and the costs are high (Balafrej et al.). The benefits of this type of procedure must be weighed against the risks of failure which could greatly affect the quality of life of the patient (Gertsch et al. 1996; Jordan & Thornby, 1994), for example, as in the dumping syndrome.

21. Reference
Balafrej S, Echarrab EM, el Ounani M, Mdaghri J, Amraoui M, el Alami FH et al. L'ulcère duodénal
hémorragique. Etude de la mortalité et des critères d'opérabilité. A propos de 557 cas.. J Chir
1997;134:406-9.
Gertsch P, Chow LW, Yuen ST, Chau KY, Lauder IJ. Long-term survival after gastrectomy for advanced
bleeding or perforated gastric carcinoma. Eur J Surg 1996;162:723-7.
Jordan PH, Jr., Thornby J. Twenty years after parietal cell vagotomy or selective vagotomy antrectomy for
treatment of duodenal ulcer. Final report. Ann Surg 1994;220:283-93; discussion 293-6.
Kyzer S, Binyamini Y, Melki Y, Ohana G, Koren R, Chaimoff C et al. Comparative study of the early
postoperative course and complications in patients undergoing Billroth I and Billroth II gastrectomy. World
J Surg 1997;21:763-6; discussion 767.
Lacaine F. Prise en charge de la maladie ulcéreuse gastrique en dehors de l'urgence: traitement
chirurgical. Gastroenterol Clin Biol 1996;20:S81-S83.
Lau WY, Leow CK. History of perforated duodenal and gastric ulcers. World J Surg 1997;21:890-6.
Michot F, Fraleu-Louer B. Prise en charge de la maladie ulcéreuse duodénale en dehors de l'urgence:
traitement chirurgical. Gastroenterol Clin Biol 1996;20:S64-S72.
Oka M, Maeda Y, Ueno T, Iizuka N, Abe T, Yamamoto K et al. A hemi-double stapling method to create
the Billroth-I anastomosis using a detachable device. J Am Coll Surg 1995;181:366-8.
Trias M, Targarona EM, Balague C, Bordas JM, Cirera I. Endoscopically-assisted laparoscopic partial
gastric resection for treatment of a large benign gastric adenoma. Surg Endosc 1996;10:344-6.
Witte CL. Is vagotomy and gastrectomy still justified for gastroduodenal ulcer? J Clin Gastroenterol
1995;20:2-3.
Witte CL. Gastric ulcer therapy. J Am Coll Surg 1997;184:337-8.
Yunfu L, Qinghua Z, Yongjia W. Pylorus and pyloric vagus preserving gastrectomy treating 125 cases of
peptic ulcer. Minerva Chir 1998;53:889-93.