全胃切除后三种Roux—en—Y消化道重建术式患者生活质量的比较

Postoperative life-quality with different alimentary reconstruction after total gastrectomy

目的对全胃切除术后不同食管空肠Roux—en—Y吻合方式患者的术后短期生活质量进行比较。方法对108例施行全胃切除术患者的临床资料进行回顾性分析。对全胃切除后消化道重建分别采用常规食管空肠Roux—en—Y吻合术（43例）、P型空肠襻食管空肠Roux—en—Y吻合术（41例）和空肠贮袋食管空肠Roux—en—Y吻合术（24例）。记录患者一般情况及术后3个月、12个月的营养状况和胃肠道症状（GSPS）评分等。结果术后3个月、12个月P型空肠襻组与常规组比较术后进食量增加（t=5．05、t=5．63，P〈0．01），而GSPS评分降低（t=15．12、t=12．42，P〈0．01）。空肠贮袋组术后3个月、12个月进食量同样优于常规组（t=8．08、t=9．28，P〈0．01），GSPS评分降低（t=18．05、t=11．01，P〈0．01）。术后12个月P型空肠襻组与空肠贮袋组体重恢复较常规组更佳（t=4．06、t=9．81，P〈0．01），而术后12个月空肠贮袋组的患者进食量又优于P型空肠襻组（t=7．52，P〈0．01），两组体重恢复之间相比差异有统计学意义（t=5．01，P〈0．01）。结论P型空肠襻和空肠贮袋食管空肠Roux—en—Y吻合术有利于维持患者术后生活质量，在某些方面行空肠贮袋又优于P型空肠襻。

Objective To evaluate quality of life （QOL） of patients receiving different Roux-en-Y alimentary reconstruction after total gastrectomy. Methods Clinical data of 108 total gastrectomy patients receiving 3 different Roux-en-Y alimentary reconstruction were analyzed retrospectively. Reconstruction procedures included respectively Ronx-en-Y esophagojejunostomy （ n = 43 ） , P-type jejunal loop Roux-en-Y （ n = 41 ） and jejunal pouch Roux-en-Y （ n = 24 ）. Body weight, eating capacity, QOL assessment by gastrointestinal symptom rating scale （GSRS）, nutritional parameters, endoscopical examination were evaluated at 3, and 12 months after surgery. Results QOL in patients with P-type loop and Jejunal pouch reconstruction procedures were better than Roux-en-Y reconstruction at short-term periods （at 3 and 12 months after surgery）, especially on eating capacity and GSPS score（ P 〈0. 0 5 ）. At 12 months after surgery, body weight and body weight recovery in Jejunal pouch group was significantly superior to that in the P-type loop group. Condusions P-type loop and Jejunal pouch reconstruction procedures provided better QOL for patients with total gastrectomy, compared with the general Roux-en-Y esophagojejunostomy. Jejunal pouch reconstruction provided further improvement of QOL in patients receiving total gastrectomy.