全胃切除术后非离断式Roux-en-Y消化道重建术的临床应用

Clinical application of non-mutilation Roux-en-Y digestive tract reconstruction after total gastrectomy

目的:探讨全胃切除术后3种消化道重建方式的临床效果。方法:将106例胃癌患者按全胃切除后消化道重建方式不同分为非离断式Roux-en-Y吻合术38例(A组)、J型空肠储袋Roux-en-Y吻合术31例(B组)和Orr式空肠食管Roux-en-Y吻合术37例(C组)。比较各组患者消化道重建时间、术后并发症发生率、进食后症状、单餐进食量、体质量和相关营养代谢指标及胃排空情况。结果:消化道重建时间A组最短,与B组差异有统计学意义(P<0.05);碱性反流性食管炎发生率3组差异无统计学意义(P>0.05),Roux潴留综合征发生率A组明显低于B、C组(P<0.05);Visick分级指数I～II级的患者比率,A组高于B、C组(P<0.05);术后6个月和12个月单餐进食量达到术前80%的患者比率,A、B组均明显高于C组(P<0.05);术后6个月3组体质量、血红蛋白、白蛋白下降程度及预后营养指数(PNI)差异无统计学意义(P>0.05),术后12个月,除血红蛋白外,体质量和白蛋白下降程度A、B组较C组低(P<0.05),PNIA、B组较C组高(P<0.05);术后1年A、B组胃半排空时间较C组明显延长(P<0.05)。结论:非离断式Roux-en-Y术是胃癌全胃切除术后消化道重建较为合适的术式。

Objective：To investigate the efficacy of three different methods of digestive tract reconstruction after total gastrectomy.Methods：A total of 106 cases underwent the uncutted Roux-en-Y esophagojejunostomy with a jejunal pouch（group A,n=38） ,Roux-en-Y esophagojejunostomy with the J-type jejunal pouch（group B,n=31） ,and Roux-en-Y esophagojejunostomy with the Orr-type jejunal pouch（group C,n=37） respectively.The clinical data were retrospectively studied.The digestive tract reconstruction time,the post-operative complication incidence rate,postprandial symptoms,food-intake quantity,weight,serum nutritional parameters and emptying time of the gastricsubstitute were compared respectively.Results：The reconstruction time was the shortest in group A,which was significantly shorter than that in group B（P0.05） .There were no significant differences among 3 groups in the incidence of alkaline refluxgastritis（P0.05） ,Group A was significantly lower than group B and C in the incidence of roux stasis syndrome.The Visick score of group A were superior to those of group B and C in 6 and 12 months after operation.The food intake gain of group A and B were superior to that of group C 6 and 12 months after operation.There were no significant differences among 3 groups in the term of weight,Hb and ALB loss and prognosis nutritional index（PNI） 6 months postoperatively.Weight and ALB loss in group A and B were lower than those in group C 12 months postoperatively,but PNI was higher in group A and B than those in group C.Emptying time of the gastric substitute was prolonged both in group A and B 12 months postoperatively.Conclusion：The uncutted Roux-en-Y esophagojejunostomy may act as an adoptable method of digestive tract reconstruction after total gastrectomy for gastric cancer.