全胃切除术后三种消化道重建术式的比较研究

Comparetive study on three types of digestive reconstruction after total gastrectomy

目的探讨全胃切除术后合理的消化道重建方式。方法对189例胃癌患者全胃切除术后分别采用了Orr式Roux-en-Y空肠食管吻合术、P形空肠袢空肠食管Roux-en-Y吻合术和Moynihan式吻合术进行消化道重建。对其手术时间、手术并发症、术后1、3年饮食状况和消化道症状及营养指标进行对比观察。结果3种术式的患者手术死亡率、术后1年和3年的饮食状况、腹泻和倾倒综合征的发生率比较,均P＞0．05；差异无统计学意义。术后1、3、5年的累计生存率比较,P＞0．05,差异也无统计学意义。Orr式空肠食管Roux-en-Y吻合术和P形空肠袢空肠食管Roux-en-Y吻合术后均能有效地防止反漉性食管炎,明显优于Moynihan式吻合术(P＜0．01)。Orr式空肠食管Roux-en-Y吻合术较P形空肠袢空肠食管Roux-en-Y吻合术操作简单、手术时间短、手术并发症也较少。结论Orr式空肠食管Roux-en-Y吻合术是胃癌全胃切除后消化道重建较为合适的术式。

Objective To investigate the rational digestive reconstruction after total gastrectomy for gastric malignancy. Methods Three types of digestive reconstruction were performed after total gastrectomy in 189 cases with gastric carcinoma. The operating time, morbidity and mortality, food intake, digestive tract symptoms, nutritional status at 1 and 3 years after surgery and 1-, 3-, 5-year cumulative survival were compared. Results There were no significant differences among the three procedures in operative morbidity and mortality, postoperative food intake, nutritional status （Hemoglobin, total protein and albium）, and incidences of diarrhea and dumping syndrome （ P 〉 0.05） . The overall 1-, 3-, 5-year survival rates were 75.3%, 38. 2% and 20. 5% respectively, and there were no significant differences among the three groups （ P 〉 0.05）. Orr-type and P-type esophagojejunostomy had an advantage of anti-esophageal reflux, and were obviously superior to Moynihan-type anastomosis （ P 〈 0. 01 ）. Compared with P-type reconstruction, Orr-type reconstruction was simpler with shorter operating time, and less complications. Conclusion Orr-type Roux-en-Y esophagojejunostomy can be recommended as an adoptable method of digestive reconstruction after total gastrectomy for gastric cancer because of its avoiding reflux esophagitis, maintaining better nutritional status and quality of life, and simpler procedure.