远端胃癌Billroth Ⅱ式术后胃肠功能快速康复的临床观察

Clinical observation on fast restoration of gastrointestinal function after gastrectomy with Billroth ΙΙ reconstruction for distal gastric cancer

目的探讨远端胃癌BillrothⅡ式术后快速康复的临床新策略——不禁水的可行性和优越性。方法回顾性分析我院远端胃癌患者156例的临床资料。随机分经鼻放置胃肠减压管及鼻肠营养管组(传统组)和空肠造口置胃管及肠内营养管术后不禁水组(创新组),比较两组病例术后肛门首次排气时间、咽喉疼痛、恶心呕吐、肺部感染、吻合口瘘和十二指肠瘘等并发症的发生率和术后住院时间。结果创新组与传统组比较,肛门首次排气时间显著提前(P<0.01),咽喉疼痛、恶心呕吐等胃管刺激不适征明显减轻(P<0.01),术后住院时间明显缩短(P<0.01),而其他指标与传统组比较差异无统计学意义(P>0.05)。结论远端胃癌毕Ⅱ式术后经空肠造口置胃管并且不禁水,安全可行,有利于患者的术后快速康复,缩短了住院时间。

Objective To investigate the feasibility and superiority of a new clinical strategy for distal gastric cancer patients receiving Billroth Ⅱ. Methods 156 patients with distal gastric cancer in our department who underwent Billroth ΙΙ were randomly divided into control group （ gastric canal and nutrient canal placed through nasal cavity group,n = 80） and experimental group were allowed to drink water after operation. First anal venting time,degree of laryngopharyngeal pain,degree of nausea and vomiting,pulmonary infection,anastomotic stoma fistulae,duodenum stump fistulae and LOS were compared between the two groups. Results In experimental group,first anal venting time was significantly ahead of schedule （ P 0. 01） ,degree of laryngopharyngeal pain and degree of nausea and vomiting caused by gastric canal was relieved,and LOS was considerably shortened. But there is no difference of the other parameters between the two groups（ P 0. 05） . Conclusion Jejunostomy and placing gastric canal is safe and feasible for gastric cancer patients receiving Billroth Ⅱ. The new treatment could shorten LOS because of postoperative fast restoration.