胃肠重建方法对胃癌全胃切除术后营养的影响

Alimentary Reconstruction Manner and Nutritional Status in Patients With Gastric Cancer After Total Gastrectomy

为了解全胃切除后胃肠道重建方法对术后病人营养状态的影响。作者于１９８９～１９９４年，对１２例胃癌全胃切除、胃及幽门括约肌重建术后病人摄取和吸收食物营养的能力进行了调查，并且与７例空肠袢重建和５例Ｒｏｕｘ－ｅｎ－Ｙ重建术后病人进行了比较，采用代谢平衡实验方法，对这些病人利用和贮存所吸收食物营养成份的情况进行了对比评价。结果表明在住院期间所有病人进食量要大于病人维持标准体重所需要的食物量，直接对照发现大多数空肠袢重建和Ｒｏｕｘ－ｅｎ－Ｙ重建的病人进食量减少，其中以空肠袢重建病人最为严重。作者认为，术后营养不良最常见的机制是进食不足，在解决好返流性食管炎的基础上，保持十二指肠食物的通过性，对于减少全胃切除术后营养不良及其它并发症的发生是极其有意义的。

To investigate the influence of the manner of digestive tract reconstruction on the nutritional status of patients undergone total gastrectomy for cancer.From 1989 to 1994, nutritional status was investigated in 24 patients, among them 12 patients with the gastric reservoir and pyloric sphincter reconstruction, 7 patients with Braun′s esophago jejunostomy and 5 patients with Lawrance's Roux en Y reconstruction. The ability of these patients to ingest and absorb nutrients was examined and compared, and metabolic balance studies were also performed to compare the efficiency of those patients to accumulate and use the absorbed nutrients.In controlled hospital 3ed situation, the amount of food ingested by all the patients was greater than that required for maintenance of ldeal Body Weight. In direct contrast, food intake in most patients with esophago jejunostomy or Roux en Y reconstruction significantly decreased when they returned to home environment, specifically in those with esophago jejunostomy,The most common mechanism of postoperative malnutrition was inadequate food intake. On the basis of resolving the problem of alkaline reflux esophagitis,preserving the duodenal food passage is imperative to reduce malabsorption and other complications after total gastrectomy.