全胃切除后非离断式Roux—en—Y空肠储袋消化道重建的临床研究

Clinical study on the alimentary canal reconstruction of uncutted Roux-en-Y with jejunal pouch for total gastrectomy

目的探讨全胃切除术后非离断式Roux-en—Y空肠储袋消化道重建方式的临床效果。方法对168例胃癌患者行全胃切除手术后分别行非离断式Roux-en—Y空肠储袋吻合术（A组，69例）、P型空肠食管Roux-en-Y吻合术（B组，50例）和Orr式空肠食管Roux—en-Y吻合术（C组，49例）进行消化道重建。观察各组患者消化道重建的时间和术后并发症发生率；并对其中无瘤生存超过1年的121例患者的生活质量[术后6和12个月时的体重、进食量、预后营养指数（PNI）和Visick分级指数]进行分析对比。结果A、B、C组消化道重建时间分别为（30±7）min、（57±6）min和（48±6）min；A组时间最短，与B、C组比较差异有统计学意义（P〈0．05）。3组患者术后均顺利恢复，未发生吻合口瘘或十二指肠残端瘘等术后并发症。A、B、C组碱性反流性食管炎发生率分别为4．3％（2／46）、7．7％（3／39）和5．6％（2／36），差异无统计学意义（P〉0．05）；Roux潴留综合征发生率分别为2．2％（2／46）、17．9％（7／39）和19．4％（7／36），A组明显低于B、C组（P〈0．01）。术后6个月和12个月，A组体重和进食量的恢复均优于B、C组（P〈0．05）。与术前相比，术后6个月3组PNI均下降（P〈0．05）；12个月时，A组PNI与术前比较差异已无统计学意义（P〉0．05），而B、C组的差异仍有统计学意义（P〈0．05）。A组术后6个月和12个月时的Visick分级指数Ⅰ～Ⅱ级均优于B、C组（P〈0．05）。结论非离断式Roux-en—Y空肠储袋术是全胃切除术后理想的消化道重建术式。

Objective To investigate the efficacy of uncutted Roux-en-Y esophagojejunostomy with jejunal pouch （URYJP） after total gastrectomy. Methods Total gastrectomy was performed on 168 patients of gastric cancer, and 3 methods were used for reconstruction： the uncutted Roux-en-Y esophagojejunostomy with a jejunal pouch was performed on 69 patients （group A）,Roux-en-Y esophagojejunostomy with the P-type jejunal pouch on 50 patients （group B）,and Roux-en-Y esophagojejunostomy with the Orr-type jejunal pouch on 49 patients （group C）. The alimentary tract reconstruction time, morbidity and mortality were compared. The 121 cases that survived for more than 1 year were analyzed for quality of life （ QOL）, including body weight, intake quantity, prognosis nutritional index （PNI）, and Visick scores 6 and 12 months after the operations. Results All the patients recovered quickly and no anastomosis leakage or duodenal fistulas were found. It took （30＋7） minutes to finish the reconstruction in group A, which was significantly shorter than that in group B [（57±6） minutes] or in group C [（48±6） minutes]. There were no significant differences among 3 groups in the incidence of alkaline reflux gastritis. The incidence of Roux stasis syndrome was 2.2% in group A, which was significantly lower than 17.9% and 19.4% in group B and C. Weight loss and food intake gain in group A was superior to those in group B and C 6 months and 12 months postoperatively. As compared with prognosis nutritional index（PNI） postoperatively, those of 3 groups decreased significantly 6 months postoperatively. At 12 months after operation, the PNI of group A returned to the level before operation, while PNI of both group B and C remained significantly lower than those before operation （both P 〈 0.05）. The Visick score of group A was superior to those of group B and C 6 months and 12 months postoperatively. Conclusions The new uncutted Roux operation with jejunal pouch can prevent alkaline reflux gastritis and Roux-en-Y stasis syndrome. It may be a standard procedure for reconstruction after total gastrectomy.