全胃切除后三种消化道重建术式比较研究

COMPARATIVE STUDY ON THREE KINDS ALIMENTARY TRACT RECONSTRUCTION PROCEDURES AFTER TOTAL GASTRECTOMY

目的比较全胃切除后三种消化道重建术式优劣,并对术后患者的营养状态及生活质量进行评估。方法选取青海大学附属医院肿瘤外科1999年4月至2007年4月间行全胃切除术病案82例,其中Roux-en-Y重建术（Orr’s）24例、布朗氏重建术（Braun’s）38例及连续空肠间置重建术（CJI）20例,比较三种术式的围手术期情况,应用OPNI指数、食物摄入、体重改变、总蛋白及血红蛋白降低值进行营养状态的评估,应用Chew-wun Wu特殊症状量表、Visick分级指数进行生活质量评估。结果Orr’s组的手术时间（200±32min）比Braun’s组（220±28min）及CJI组（205±35min）的手术时间明显缩短（P〈0.05）。术后第6个月时CJI组的OPNI指数比另外两组明显升高（P〈0.05）,同时CJI组体重恢复情况与另外两组比较具有明显差异（P〈0.05）,随访至术后12个月时三组的营养指标没有统计学意义。Orr’s组和CJI组术后第3个月、第6个月和第12个月的Visick Ⅰ~Ⅱ级构成比高于Braun’s组（P〈0.05）。Chew-wun Wu 14项特殊症状量表问卷调查结果显示术后第3个月时Braun’s组反流及烧心症状明显于其他两组（P〈0.05）。结论Orr’s消化道重建手术操作时间短,但是术后患者营养状态较差,不能改善术后患者的生活质量;Braun’s消化道重建术后返流明显,但是术中无需切断空肠,保持了空肠的连续性;CJI可以改善患者短期营养状态,提高短期生活质量,但并不能改善患者长期营养状态和生活质量。

Objective To evaluate patients＇ quality of life and nutritional status by comparing three different alimentary tract reconstruction procedures after total gastrectomy.Methods A total of 82 patients who underwent total gastrectomy for gastric malignant tumor from April 1999 to April 2007 in Affiliated Hospital of Qinghai University were enrolled for this study,and assigned to the following three groups ： 24 patients to the group of Orr＇s Roux-en-Y reconstruction（Orr＇s）,38 patients to the group of esophajejunostomy with a Braun＇s jejunojejunostomy（Braun＇s） and 20 patients to the group of continuous jejunal interposition reconstruction（CJI）.The patients＇ perioperative characteristics were comparatively studied.Moreover,the total protein decline of hemoglobin、the OPNI and body weight loss were comparatively analyzed for assessment of the patient＇s nutritional status.Meanwhile,the Chew-wun Wu treatment-specific symptoms questionnaire and Visick score were used to evaluate the patient＇s quality of life.Results The operative time of Orr＇s group（200±32min） was comparatively shorter than that of Braun＇s group（220±28min） and CJI group（205±35min）.As compared with Orr＇s group,Braun＇s group and CJI group which had duodenal passage showed better body weight,higher nutritional parameters and OPNI at 6 months after operation（P〈0.05）,but no significant differences among the three groups 1 year after operation.Constituent ratio of Visick scores I～II of CJI group and Orr＇s group in 3、6 and 12 months were higher than that of Braun＇s group（P〈0.05）.Additionally,The patients from Braun＇s group whose feeling of heartburn and reflux according to the follow-up survey outcomes from questionnaire of Chew-wun Wu treatment-special symptoms were remarkably serious in 3 months after operation by comparison with that of the other groups.Conclusion the operative time used in the Orr＇s reconstruction was comparatively shorter than that used in the Braun＇s group and CJI group,but patients who were performed the Orr＇s surgical procedure were poor of nutritional status and quality of life.CJI showed beneficial effects on clinical outcomes in 6 months postoperation.Among the three reconstruction procedures,CJI can improve the quality of patient＇s life and benefit to the nutritional status after operation in 6 months,but after 1 year there indicated no beneficial to the quality of life and nutritional status.Patients who underwent Braun＇s reconstruction felt seriously heartburn and reflux in 3months after operation,but Braun＇s method kept the jejuna continuity without jejunal transection.