功能性双腔空肠间置代胃术在全胃切除后消化道重建中的临床应用研究

Study on Clinical Application of Functional Double Pouch Jejunum Interposition after Total Gastrectomy

目的探讨全胃切除术后消化道重建的合理术式。方法回顾性分析张掖市甘州区医院2000年1月至2005年10月期间行全胃切除术后资料完整的63例患者的临床资料,根据手术方式不同分为功能性双腔空肠间置代胃术(double pouch jejunum interposition,DPJI)即DPJI组(n=30)和"ρ"形Roux-en-Y空肠代胃术(Roux-en-Yρpouch,RYρ)即RYρ组(n=33),分析2组间的手术时间、并发症、饮食数量与次数、消化道症状、总蛋白和白蛋白的差异。结果DPJI组与RYρ组在手术时间、并发症发生率、饮食量与饮食次数之间差异均无统计学意义(P>0.05);DPJI组总的消化道症状发生率低于RYρ组(P<0.05)。Vervaeck指数Ⅰ/Ⅱ级者DPJI组多于RYρ组,2组差异有统计学意义(P<0.05);DPJI组血浆白蛋白与总蛋白含量均高于RYρ组,差异有统计学意义(P<0.05)。结论DPJI是一种全胃切除后较合理的消化道重建术式。

Objective To investigate for a reasonable reconstruction method in patients undergoing total gastrectomy. Methods Data of 63 cases receiving total gastrectomy from January 2000 to October 2005 in Ganzhou District Hospital of Zhangye City were analyzed retrospectively, and the patients were divided into double pouch jej unum interposition （DPJI） group （n = 30） and Roux-en-Yρ pouch （RYρ） group （n = 33） according to the operation methods, then operation time, morbidity of complications, amount and frequency of meat and drink, complications of digestive tract, amount of total protein and albumin were compared between two groups. Results There were no significant differences in operation time, morbidity of complications, the amount or frequency of meat and drink between two groups （P〉0.05） ; but the incidence of digestive tract complications of DPJI group was lower than that of RYρ group （P〈0.05）. Grade Ⅰ/Ⅱ of Vervaeck index and the amount of total protein and albumin in DPJI group were statistical significantly higher than those of RYρ group （P〈0.05）. Conclusion Functional DPJI is a reasonable digestive tract reconstruction method.