全胃切除术后3种消化道重建方式的对比研究

Comparative study on three types of digestive reconstructions after total gastrectomy

目的探讨全胃切除术后合理的消化道重建方式。方法自2002年6月～2005年6月,对105例全胃切除术分别采用Schlatter式、Orr式及SS式3种不同的消化道重建方式,对术中消化道重建时间、术后6个月和24个月病人饮食情况、消化道症状和营养指标进行对比观察。结果3种术式术中消化道重建时间无显著差异(P>0.05)。术后6个月,Schlatter式术组病人返流性食管炎和营养不良的发生率明显高于Orr式术组及SS式术组(P<0.01)。术后6个月,3组病人体重增加、血红蛋白、血清总蛋白和血清白蛋白指标比较差异无显著性(P>0.05),但在术后24个月,SS式术组病人的上述指标有明显提高(P<0.0P)。结论全胃切除术后采用SS式间置空肠代胃,操作简便可行,可保留食物十二指肠通道连续性,能降低术后并发症和提高生活质量。

Objective To investigate the rationality of different types of digestive reconstruction after total, gastrectomy.Methods From June 2002 to June 2005, three different types of digestive reconstruction were performed in 105 cases of total gastrectomy for gastric malignant tumor.The anastomotic time, complications, food intake,digestive tract symptoms as well as the nutritional status at 6 months and 24 months after surgery were comparatively analyzedagesuits There was no significant difference in the anastomotic time among three groups （P〉0.05）.Patients in Schlatter-type group suffered from higher rate of reflux esophagitis and malnutrition than SS-type group and Orr-type group at 6 months after surgery （P〈0.01）. Patients＇ body weight increase, hemoglobin, total protein and albumin were no significant difference among three groups at 6 months after surgery （P〉0.05）, but those indexes were significantly higher in SS-type group than Schlatter-type group and Orr-type group at 24 months after surgery （P〈0.05）.Conclusion The SS-type jejunal in- terposition substitute stomach, which restoring the duodenal passage, is a convenient procedure for digestive reconstruction after total gastrectomy.It can improve quality of life and reduce complications.