间置空肠代胃与Roux-en-Y吻合法消化道重建对病人生存质量影响的研究

The influence of jejunal pouch interposition in comparison with Roux-en-Y reconstruction after total gastrectomy on postoperative quality of life

目的评估全胃切除术后,间置空肠代胃术(jejunalpouchreconstruction,JIP)和RouxenY吻合法消化道重建对病人生存质量的影响,以选择最佳的重建方法。方法回顾性分析1990年1月至2002年10月168例病人行全胃切除术后,分别行JIP和RouxenY吻合消化道重建病人术后1年的进食量、体重、血浆营养参数变化、代胃肠管的储存及排空功能、食管下段胆酸及pH值等术后生存质量指标。结果JIP组间置空肠扩张,术后营养状态及生存质量优于RouxenY吻合组,且消化道不良症状及胆汁反流发生率明显低于后者。结论全胃切除后,采用间置空肠消化道重建简单易行,并可明显提高病人术后的生活质量。

Objective To establish the ideal reconstruction form after total gastrectomy,the postoperative gastrointestinal function and symptoms of jejunal pouch interposition (JIP) were investigated in comparison with Roux-en-Y reconstruction.Methods One hundred and sixty-eight patients with gastric cancer who underwent total gastrectomy from 1990 to 2002 were divided into the Roux-en-Y reconstruction group or the jejunal pouch reconstruction group (JIP group).At 1 year after surgery,patients body weight and the serum total protein,eating capacity,quality of life (QOL) assessed by gastrointestinal symptom rating scale (GSRS),nutritional parameters,endoscopical examination,oesophageal pH and Bilitec value were compared between the two groups.Results There were less jejunal dilatation and better nutritional status and QOL in JIP group.Moreover,bad symptoms of digestive tract and incidence of bile reflux into the esophagus in JJP group was less.Single-layer suture is safe and simple,and suited for manual suture.Conclusion JIP reconstruction by single-layer suture after total gastrectomy is simple and safe,and improves QQL of patient.