胃癌患者全胃切除术后两种消化道重建术式的比较

Comparative study on two types of digestive reconstruction after total gastrectomy in patients with gastric carcinoma

目的比较胃癌患者全胃切除术后两种消化道重建术式的临床效果及术后并发症。方法对50例胃癌患者全胃切除术后分别采用Roux-en-Y食管空肠吻合术和P形袢空肠代胃术进行消化道重建，观察两种术式手术时间及术后并发症情况。结果Roux-en-Y食管空肠吻合术和P形袢空肠代胃术两种术式的术后消化道症状分别为：腹泻（11．8％与12．1％）、倾倒综合征（3．9％与3．3％）和反流性食管炎（5．9％与6．0％）差异无统计学意义（均P〉0．05）；P形袢空肠代胃术组术后并发症（13．0％）稍高于Roux—en—Y食管空肠吻合术（11．1％），但差异无统计学意义（P〉0．05）；Roux-en-Y食管空肠吻合术组平均手术时间（3．1±0．3）h，较P形袢空肠代胃术组（3．7±0．2）h明显缩短（t=3．35，P〈0．05）。结论胃癌患者全胃切除术后，Roux—en—Y食管空肠吻合术和P形袢空肠代胃术均为比较理想的消化道重建术式，但前者手术时间较短。

Objective To compare two types of digestive reconstruction and postoperative complications after total gastrectomy in patients with gastric carcinoma. Methods Roux-en-Y esophagojejunostomy and P-type Roux-en- Y esophagojejunostomy were performed in 50 patients with gastric carcinoma after total gastrectomy. The operating time and postoperative complications were observed. Results The gastrointestinal symptoms for Roux-en-Y esophagojejunostomy and P-type Roux-en-Y esophagojejunostomy serve as： diarrhea （ 11.8% and 12. 1% ）, dumping syndrome （3. 9% and 3.3% ） and reflux esophagitis （ 5.9% and 6.0% ）, the incidence of the difference was not significant （than,P 〉 0. 05）. The postoperative complications in P-type Roux-en-Y esophagojejunostomy（ 13. 1% ）slightly higher that Rou.x-en-Y esophagojejunostomy（ 11.1% ）, but the difference was not significant （.P 〉 0. 05 ）. Roux-en-Y esophagojejunostomy average operative time（3.1 ＋ 0. 3 ）h was significantly reduced than P-type Roux-en-Y esophagojejunostomy（3.7 ＋ 0.2）h（t =3.35,P〈0.05）. Conclusion Roux-en-Y esophagojejunostomy and P-type Roux-en-Y esophagojejunostomy is a suitable type after total gastrectomy for patients with gastric carcinoma, but the former operatire time was shorter.