全胃切除三种消化道重建术式术后生活质量评估

Evaluation on lift quality after digestive tract reconstruction of three kinds of total gastrectomy

目的评估全胃切除术后三种不同的消化道重建术式对患者生活质量的影响,以探讨合理的消化道重建方式。方法自1994年1月至2004年1月,我们对96例全胃切除术患者分别采用了Orr式食管空肠Roux鄄en鄄Y吻合术、P式食管空肠Roux鄄en鄄Y吻合术及“6”字型间置空肠代胃术三种不同的消化道重建术式,并对其手术并发症、术后2周与2个月的营养指标、饮食状况及消化道症状进行对比。结果在三组患者中,“6”字型术组患者术后并发症发生率最高;Orr式术组倾倒综合征及反流性食管炎发生率明显高于P式术组及“6”字型术组,P式术组与“6”字型术组患者的差异无临床意义;Orr式术组患者术后2周与2月的体重、总蛋白、白蛋白及血红蛋白明显低于P形术组及“6”字型术组,P式术组与“6”字型术组患者术后2周与2月的差异无显著意义。结论P式空肠食管Roux鄄en鄄Y吻合术操作更简便,患者术后营养状况好、生活质量高,是全胃切除后消化道重建较为理想的术式。

Objective To evaluate the effect on lift quality after digestive tract reconstructian of three kinds of total gastrectomy and investigate the reasonable reconstructed manner of digestive tract. Methods From Jan 1994 to Jan 2004,three kinds of digestive tract reconstruction were performed in 96 cases with total gastrectomy.It was compared to operative complications,nutritive index 2 weeks and 2 months after operation,dietary status and digestive symptoms.Results Among three kinds of digestive tract reconstruction,the postoperative complication rates were most high in the operation of 6 figure type.In the dumping syndrome and regurgitated esophagitis rates,the Orr′s type was obviously higher than that P type and 6 figure type and there was no difference in the P type and 6 figure type.Orr type group was obviously lower than that P type group and 6 figure group in the body weight,total protein,albumin and hemoglobin 2 weeks and 2 months after operation.There was no significant difference in the P type group and 6 figure type group 2 weeks and 2 months after operation.Conclusion P type Roux-en-Y esophagojejunostomy posesses simple manipulation,a good postopera-tive nutritive status and a high quality of life.It is one of desirable operation manmer in the digestive tract reconstruction after total gastrectomy.