胃切除部位的不同和全胃切除术后消化道重建术式的不同对生活质量的影响探讨

To probe the effects of gastrectomy and different reconstruction procedures after total gastrectomy on quality of lief

目的研究胃癌全胃切除术(TG)同胃次全切除术(SG)后患者的生活质量差异,评估全胃切除术后3种不同的消化道重建术式对患者生活质量的影响。方法 343例胃癌患者中全胃切除术96例,远端胃次全切除术135例,近端胃次全切除术112例,对其在生活质量方面进行了比较。全胃切除术患者分别采用Orr式食管空肠Roux-en-Y吻合术、9字形食管空肠Roux-en-Y吻合术及6字形间置空肠代胃术,并对此3种不同的消化道重建术式的术后并发症及营养等方面进行对比。结果餐后腹胀、食欲下降远端胃次全切除术的发生率远低于近端胃次全切除术和全胃切除术(P<0.05);近端胃次全切除术反流的发生率要高于远端胃次全切除术和全胃切除术(P<0.05),其发生率均有随时间推移下降的趋势。三种消化道重建术式术后生活质量以Orr式术组最差,9字形术组居中,"6"字形术组最高。结论胃切除部位的不同是生活质量差异的重要因素;9字形Roux-en-Y食管空肠吻合术操作更简便,患者术后营养状况好、生活质量高,是全胃切除后消化道重建较为理想的术式。

Objective The aim of this study was to compare the quality of life （QOL） after TG wih that after subtotal gastrectomy（PSG＆DSG） for gastric carcinoma and to analyse the factors affecting QOL after TG. To probe the effect of three different digestive tract reconstruction on patient＇s living quality after total gastrectomy for gastric tumors. Methods 343 patients underwent gastrectomy（96 after TG, 135 after DSG and 112 after PSG）. The EORTCquality of life questionnaire QLQ - STO20 was used in the present retrospective study to assess quality of life of gastric cancer patients following radical surgical procedures. Three different types of digestive tract reconstruction were adopted in 96 cases of total gastrectomy. The complications, nutrition, and symptoms were analyzed. Results Gastric tidiness occurred in each group but the rate was lower in DSG group than in the other two （21.6% vs 74. 1% ,63.0% ,P 〈0. 05 ）. It was found that symptoms of reflux esophagitis were worse in PSG group than in the other two though an improvement happened in each group （60.2% vs20.2% ,23.0% ,P 〈 0.05 ）. Early dumping symptoms were seen less in PSG group than in the other two（0% vs14.3% , 16. 7% ,P 〈0.05 ）. Patients in Orr - type group suffered from higher rate of reflux esophagitis（ 8.7% ,0,0） , dumping syndrome （60.9% ,4.9% , 0 ） and malnutrition （21.7 % ,2.4% ,0 ）than 9 - type group and＂6＂ type group. Conclusion The different site being resected is the cause for better QOL of DSG group than that of PSG and TG group. 9 - type Roux - en - Y esophago jejunostomy is a procedure of choice for digestive tract reconstruction after total gastrectomy for patientswith gastric tumors, in terms of better postoperative living quality and better nutrition state.