连续性空肠间置在胃次全切除术消化道重建中的应用研究

Clinical study of continual jejunal interpostion after subtotal gastrectomy

目的探讨胃次全切除术时采用连续性空肠间置完成消化道重建的临床效果。方法远端胃癌患者34例,随机分成两组,A组16例,B组18例。胃次全切除后,A组行残胃与空肠、十二指肠与空肠的端侧吻合,再行空肠侧侧吻合,将胃空肠吻合的输入袢空肠和十二指肠空肠吻合口的输出袢空肠分别结扎阻断,形成完整的连续性间置空肠代胃。B组行BillrothⅡ式消化道重建。比较两组患者术后并发症发生率和死亡率;术后1年比较两组患者的Visick分级指数、血浆白蛋白水平、每餐进食量和体重,并用胃镜检查残胃和吻合口情况。结果两组患者术后均未出现并发症。术后1年观察,Visick分级指数两组比较,u=2.1,P<0.05;差异有统计学意义。A组所有患者平均每日进食量均在术前水平的85%以上,B组只有14人达到该水平。两组手术前后体重减少值比较,t=-2.181,P<0.05;差异有统计学意义。两组手术前后血浆白蛋白变化值对比,差异有统计学意义(t=2.125,P<0.05);A组在1年后显著增加,与术前相比(t=-2.175,P<0.05)差异有统计学意义。手术后1年胃镜复查,A组残胃未发现胆汁反流,吻合口通畅,吻合口黏膜和间置空肠无充血、水肿,而B组发现残胃内胆汁潴留11例(61.1%),吻合口炎症13例(72.2%),吻合口溃疡2例(11.1%)。结论连续性空肠间置能够恢复消化道生理通道并避免反流性胃炎的发生。

Objective To explore the clinical effect of continual jejunal interposition in digestive tract reconstruction after subtotal gastrectomy. Methods Thirty-four patients with distal gastric cancer were divided randomly into two groups. In group A, the digestive continuity was reconstructed by continual jejunal interposition in 16 patients after subtotal gastrectomy. In group B, the digestive tract of other 18 cases were reconstructed by BiUroth Ⅱ procedure. The postoperative complications, nutritional status, food intake and gastorscopic results were compared. Results There were no complications such as anastomotic leakage or obstruction in the two groups. The Visick scoring of group A was better than that of group B, and the difference was significant one year after operation （ u = 1.98, P 〈 0.05） . All patients retrieved 85% of preoperative food intake per meal in group A, while only 14 patients got such results in group B. The weight loss was significantly higher in group B than that in group A（ t = - 2. 181, P = 0. 037） after operation. The serum albumin level after operation in group A was significantly higher than that in group B（ t =2. 125, P = 0. 041 ）, the level one year after operation in group A was also significantly higher than that before operation （ t = - 2.175, P = 0.011 ）. Gastroscopy one year after operation revealed fluent stoma, no bile reflux, and no congestion and edema in stomal mucusa and interposed jejunum in group A, while bile retention in 11 cases （61.1%）, stomal inflammation in 13 cases（72. 2% ）, and stomal ulcer in 2 cases（ 11.1% ） in group B. Conclusion Continual jejunal interposition after subtotal gastrectomy can recover physiological continuity of digestive tract and improve the quality of life without reflux gastritis.