全胃切除术后两种消化道重建术式的比较

Effect of the two digestive tract procedures after total gastrectomy on postoperative life quality

目的探讨全胃切除术后两种消化道重建术式手术操作时间、病人术后生活质量的影响。方法对2003年1月-2007年6月我院施行全胃切除术的218例病人的临床资料进行回顾性分析。全胃切除后消化道重建分别采用P型空肠袢食管空肠Roux—en—Y吻合术（PR法）（A组，96例）和改良空肠间置代胃吻合术（FJI法）（B组，44例）。记录术中消化道重建时间、术后12个月营养状况和胃肠道症状（GSRS）评分等。结果消化道重建术所需时间两组比较，差异无统计学意义（P〉0．05）。术后12个月B组与A组比较，进食量明显增加（P〈0．05），而GSRS评分降低（P〈0．05）。术后12个月B组体重恢复较A组更佳，差异有统计学意义（P〈0．05）。结论改良空肠间置代胃吻合术有利于维持病人术后生活质量，在每天进食量及体重恢复方面改良空肠间置代胃吻合术优于P型空肠袢食管空肠Rottx—en—Y吻合术。

Objective To evaluate time of digestive tract reconstruction and quality of life（QOL）of patients receiving different alimentary reconstruction following total gastrectomy. Methods Clinical data of 218 tohal gastrectomy patients receiving 2 different alimentary reconstruction were analyzed retrospectively. Reconstruction procedures included respectively PR（ n = 96）and FJI （n = 44）. Body weight, eating capacity and QOL assessment by gastrointestinal symptom rating scale（GSRS）and nutritional parameters were respectively evaluated at 12 months after surgery. Results QOL in patients with FJI reconstruction procedures were better than that of PR reconstruction at 12 months after surgery,especially on eating capacity and GSPS scores（P 〈0.05）. At 12 months after surgery, body weight recovery of FJI group was significantly superior to that of the PR group. Conclusions Compared with PR, FJI reconstruction procedures provided better QOL for patients with total gastrectomy, especially in daily food intake and body weight recovery.