胃癌全胃切除术后不同形式消化道重建术式疗效评价

Total gastrectomy for gastric cancer of the digestive tract reconstruction of the different forms of the recent evaluation

目的评价胃癌全胃切除术后不同形式消化道重建术式的临床效果。方法我院2001年1月-2006年1月对288例胃恶性肿瘤患者行全胃切除术后分别采用Orr式Roux-en-Y空肠食管吻合术、P形空肠袢空肠食管Roux-en-Y吻合和Moynihan式吻合术进行消化道重建。对3种手术方式的手术时间、术中出血量、手术并发症、手术死亡率、术后半年消化道症状及营养指标进行对比观察。结果P形空肠袢空肠食管Roux-en-Y吻合术的手术时间与其他两组比较,差异有统计学意义（P〈0.05）。术后半年Orr式Roux-en-Y空肠食管吻合术上腹饱胀及倾倒综合征的发生率高于P形空肠袢空肠食管Roux-en-Y吻合术和Moynihan式吻合术（P〈0.05）;Moynihan式吻合术反流性食管炎的发生率明显高于其他两种术式（P〈0.01）;P形空肠袢空肠食管Roux-en-Y吻合术患者体重增加及营养指标优于Orr式Roux-en-Y空肠食管吻合术和Moynihan式吻合术患者。结论P形空肠袢空肠食管Roux-en-Y吻合术是胃癌全胃切除后消化道重建较为合适的术式。

Objective To appraise the clinical effects of different reconstructive modes of alimentary canal for total gastrectomy.Methods Two hundred and eighty-eight cases of stomach malignant tumor patients who have taken entire stomach excision in my courtyard from January 2001 to January 2006 were undertook Orr-type Roux-en-Y reconstruction,P-type Roux-en-Y reconstruction and the Moynihan-type anastomosis was carried on the digestive tract reconstruction.The surgery time,surgery leaves,volume of blood,surgery complication,surgery mortality rate,technique latter part digestive tract symptom and the nutritive index carried on the compare were observed during the three surgery method.Results The P-type Roux-en-Y reconstruction surgery time was different from others,and the difference existed a statistically significantion（P0〈.05）.After six months,the incidence of abdomen distension and dumping syndrome of Orr-type Roux-en-Y anastomosis was higher than P-type Roux-en-Y reconstruction and Moynihan-type anastomosis（P〈0.05）.The incidence of reflux esophagitis of Moynihan-type anastomosis is higher than that of the other two methods（P〈0.01）.The reconstruction weight and nutrition indicators of P-type Roux-en-Y was better than Orr-type Roux-en-Y reconstruction and Moynihan-type anastomosis.Conclusion P-type Roux-en-Y reconstruction can be recommended as an adoptale method of digestive reconstruction after total gastrectomy for gastric cancer.