胃癌切除后三种重建方式术后患者生活质量的比较

Comparison of quality of life following three types of reconstruction procedures after gastrectomy for gastric cancer

目的探讨胃癌不同切除和重建方式对患者术后生活质量的影响。方法随访我科4年间所行胃癌切除手术的患者,选择其中生存2年以上的6 1例(近端胃大部切除食管胃吻合1 3例、全胃切除空肠P型重建1 8例、空肠双Braun重建3 0例)作为观察对象。通过对患者1 4项随访内容的反馈,对其生活质量进行评价。同时对1 2例不同重建方式的患者,进行贮袋99mTc核素排空功能检测。结果手术后6个月,各指标3组之间的差异无统计学意义;手术后1 2个月,双Braun重建比P型重建和食管胃吻合在进食时间(P<0.0 5)、进食次数(P<0.0 5)、体重(P<0.0 1)方面有明显的优势;手术后2 4个月,双Braun重建在体重改善方面优于P型重建和食管胃吻合(P<0.0 1)。食物在双Braum重建的贮袋中存留的时间比其他2种重建方式延长(分别为P=0.0 0 1;P=0.0 0 2)。结论全胃切除双Braun重建手术术后患者近期生活质量优于P型重建和食管胃吻合术;双Braun重建的贮袋具有良好的食物存储功能。

Objective To analyze the quality of life （ QOL ） of gastric cancer patients who underwent different types of gastrectomy and digestive tract reconstruction procedures. Methods Among the patients who underwent gastrectomy in our department over a period of 4 years, 61 cases that survived for more than 2 years were analyzed for QOL using 14 parameters. The 61 cases included 13 cases of proximal subtotal gastrectomy and esophagogastrostomy, 18 cases of total gastrectomy and jejunal P pouch reconstruction, and 30 cases of total gastrectomy and double Braun type of jejunal reconstruction. Pouch emptying function in 12 patients with different types of reconstruction was determined in by Isotope 99mTC scintigraphy. Results At 6 months after operation, the parameters showed no significant differences between the 3 groups. At 12 months after operation, the QOL of patients with double Braun-type reconstruction was superior to that of patients with P jejunal pouch and patients with esophagogastrostomy in intake time（ P 〈 0.05 ） , intake frequency （ P 〈 0.05 ） and body weight gain （ P 〈 0. 05 ） . At 24 months after operation, the double Braun-type reconstruction group was superior to the other two reconstruction groups in body weight gain （ P 〈 0.05 ） ; and retention time of food after the double Braun reconstruction was longer than that after the other two types of reconstruction （ P = 0.001 , P = 0. 002, respectively ）. Conclusions Patients undergoing total gastrectomy and double Braun reconstruction have a better postoperative QOL in the short term as compared to that of jejunal P pouch reconstruction and esophagogastrostomy. The double Braun reconstruction provides excellent food storage function.