全胃切除术后连续性空肠间置代胃术消化道重建的临床应用

Gastrointestinal reconstruction by continuous jejunal interposition after total gastrectomy

目的探讨全胃切除术后消化道重建的合理术式。方法回顾186例全胃切除术患者术后完整资料及随访12个月的结果,以功能性连续性空肠间置代胃术组(FJI组,92例)为研究组,以"ρ"形Roux-en-Y空肠代胃术组(RYρ组,94例)为对照组,观察手术时间、术后并发症、消化道症状、营养状况等指标。结果与RYρ组相比,术后12个月时,FJI组胃潴留综合征发生率、体重减轻分别为8.70%和(4.1±1.5)kg,明显低于RYρ组[分别为22.34%和(6.5±2.0)kg,P<0.05];术后12个月VisickⅠ/Ⅱ级、血清白蛋白、血红蛋白水平分别为78.26%、(4.3±1.1)g/L、(149±6.1)g/L,均明显高于RYρ组[分别为62.77%、(3.6±1.0)g/L、(130±5.8)g/L,P<0.05],营养指数明显优于RYρ组。FJI组在饮食量与饮食次数、反流性食管炎、腹泻等方面与RYρ组无明显差异,所有患者在随访期间均无肿瘤复发和转移,无死亡病例,并发症发生率为2.69%。结论 FJI是一种操作不太复杂、并发症少、安全、易于推广的全胃切除术后消化道重建术。

Objective To investigate for a reasonable reconstruction method in patients undergoing total gastrectomy.Methods Datum of 186 patients receiving total gastrectomy and following up for 12 months were analyzed retrospectively,the patients in control group were treated with continuous jejunal interposition(FJI)(n=92),the patients in experimental group were treated with Roux-en-Yρ-pouch(RYρ)(n=94),then the operation time,postoperative complications,symptoms of digestive tract,nutritional status of patients were compared.Results Compared with RYρ group,12 months after operation,the gastric retention ratio and body weight loss was 8.70% and(4.1±1.5)kg in FJI,respectively,it's significant lower than that in RYρ[22.34% and(6.5±2.0)kg,respectively,P<0.05].The level of VisickⅠ/Ⅱ,serum albumin,haematoglobin was 78.26%,(4.3±1.1)g/L,(149±6.1)g/L,respectively,it's significant higher than that in RYρ[62.77%,(3.6±1.0)g/L,(130±5.8)g/L,P<0.05].The nutritional index in FJI was significant better than that in RYρ.There were no significant differences in amount,frequency of food and drink,reflux esophagitis and diarrhea between FJI and RYρ groups.During the follow-up period of 12 months,there were no tumor palindromia and metastasis,no patient death.The complication ratio was 2.69%.Conclusions FJI is a no-more-complicated,less-complication,safety,easily-spreading digestive tract reconstruction.