根治性近端胃切除术后的两种重建术式评价

Evaluation of Two Digestive Tract Reconstruction Procedures of Proximal Gastrectomy

目的探讨近端胃癌根治术后合理的消化道重建方式。方法回顾性总结2004年6月至2007年1月期间我院行近端胃癌次全胃切除连续病例59例,依据重建方式分为2组:胃食管侧端吻合重建组(GE组)和调节型双通道间置空肠重建组(GIE组),GIE组重建在残胃与食管间增加一段长35cm的连续性间置空肠,对比分析2组术后患者生活质量状况。结果全组病例无围手术期死亡、吻合口漏、倾倒综合征及中度以上贫血病例发生。术后1和6个月体重、RBC、Hb、Alb、PNI值以及其相对于术前的变化值〔术后1个月RBC(P=0.006)、Hb(P=0.001)相对于术前的变化值除外〕,GIE组和GE组间差异均无统计学意义(P>0.05)。GIE组术后腹部症状和反流性食管炎症状的Visick评分优于GE组(P<0.001):GIE组主要为Ⅱ级(74.2%),GE组主要为Ⅲ级(64.3%)。与GE组比较,GIE组术后并未延迟首次化疗时间(P>0.05),手术时间延长(0.35±0.13)h(P=0.01)。结论调节型双通道间置空肠消化道重建在近端胃次全切除术中是安全、可行的,有利于防止癌细胞残留和改善近端胃癌根治术后患者生活质量。

Objective To explore the optimal technique for digestive tract reconstruction of proximal gastrectomy. Methods Fifty-nine patients who underwent proximal subtotal gastrectomy during June 2004 and January 2007 were analyzed retrospectively. All patients were divided into 2 groups according to the styles of reconstruction： one group with gastroesophagostomy （GE group） and the other with accommodation double tract digestive reconstruction of jejunal interposition （GIE group）. The reconstruction of GIE group was to interposite a continuous 35 cm jejunum between the gastric stump and the oesophagus, which detail had been reported in our previous literature. The quality of life in 2 groups were evaluated and compared. Results No patient died and there was no anastomotic leakage, dumping syndrome and moderate or severe anemia occurred during perioperative period. There was no significant difference of the following indexes of nutrition between 2 groups 1 month and 6 months after operation： the value of weight, RBC, Hb, AIb, PNI and the indexes versus the preoperative ones （P〉0.05）, for the exception of the indexes of RBC （P=0. 006）, Hb （P=0. 001） in 1 month after operation versus the preoperative ones. The abdominal and the reflux esophagitis symptoms in GIE group were milder than those in GE group （P〈 0.001）. The Visick scoring： most of the GIE group were grade Ⅱ（74. 2%）, and grade Ⅲ （64.3%） in the GE group. There was no delay of the first time of adjuvant chemotherapy in GIE group （P〉0.05）, and the surgical time was （0.35±0.13） h more than that of GE group （P=0.01）. Conclusion The accommodation double tract digestive reconstruction of jejunal interposition for proximal subtotal gastrectomy may be safe and feasible by decreasing residual cancer cells and improving the quality of life of patients with proximal gastric carcinoma who underwent such surgical procedure.