全胃切除术后三种消化道重建术式对患者生活质量的影响

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

目的:探讨全胃切除术后三种消化道重建术式对患者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例患者的临床资料进行回顾性分析。全胃切除后消化道重建分别为常规端侧食管空肠Roux-en-Y吻合术78例(A组)、P型空肠袢食管空肠Roux-en-Y吻合术96例(B组)和改良空肠间置代胃吻合术(FJI法)44例(C组)。记录患者一般情况及术后12个月的营养状况和胃肠道症状(GSRS)评分等。结果:术后12个月,B组与A组比较,进食量明显增加(P<0.05),而GSRS评分明显降低(P<0.05);C组与A组比较,进食量亦明显增加(P<0.05),GSRS评分则明显降低(P<0.05)。术后12个月,B组与C组体重恢复较A组更佳(P<0.05),且C组患者的进食量又优于B组,B、C两组体重恢复比较,差异有统计学意义(P<0.05)。结论:P型空肠袢和改良空肠间置代胃吻合术均有利于维持患者术后生活质量。在每天进食量及体重恢复方面,改良空肠间置代胃吻合术更优于P型空肠袢食管空肠Roux-en-Y吻合术。

Objective：To evaluate quality of life（QOL） of patients receiving different alimentary reconstruction following total gastrectomy. Methods： Clinical data of 218 total gastrectomy patients receiving 3 different alimentary reconstruction were analyzed ret- rospectively. Reconstruction procedures included respectively Roux-en-Y esophago jejnnostomy（ n = 78 ）, P-type jejunal loop Roux-en- Y （n = 96 ）and FJI （n = 44 ）. Body weight, eating capacity, QOL assessment by gastrointestinal symptom rating scale （GSRS）, nutrition- al parameters, and endoscopical examination were respectively evaluated 12 months later after surgery. Results：QOL in patients with P-type loop and FJI reconstruction procedures were better than routine Roux-en-Y reconstruction 12 months later after surgery, especial- ly on eating capacity and GSPS scores （ P 〈 O. 05 ）. Twelve months later after surgery, body weight recovery of FJI group was significant- ly superior to that of the P-type loop group. Conclusion： P-type loop and FJI reconstruction procedures provided better QOL for patients with total gastrectomy, compared with the routine Roux-en-Y esophagojejunostomy. FJI reconstruction provided further improvement of QOL in patients receiving total gastrectomy.