全胃切除术后3种不同空肠构建贮存袋与保持十二指肠连续性消化道重建患者生活质量的比较

Influences of three types of digestive tract reconstruction on quality of life after total gastrectomy

目的对胃癌全胃切除术后3种不同空肠构建贮存袋与保持十二指肠连续性的消化道重建方式患者术后短期生活质量进行比较。方法自2000年3月至2007月12月对62例施行胃癌全胃切除术患者采用3种不同的空肠构建贮存袋消化道重建，其中功能性空肠间置代胃（FJI）型23例、袢式空肠代胃改良m（BraunⅢ）型20例、空肠代胃P型19例，记录患者一般情况及术后3和12个月的营养状况及胃肠道症状评分等。结果P型与FJI及Ⅲ型手术持续时间差异具有统计学意义（P〈0．01）；3种术式术中出血量、术后并发症和术后3个月每餐进食量差异无统计学意义（P〉0．05）；术后12个月与术后3个月比较，3组患者每餐进食量均有上升，差异具有统计学意义（P〈0．01），FJI型、Ⅲ型和P型3组的血红蛋白及血清钙明显升高，前后对比差异具有统计学意义（P〈0．01）。3组血清白蛋白比较，FJI型术后12个月高于术后3个月，差异具有统计学意义（P〈0．05）；Ⅲ型和P型术后12个月有高于术后3个月的趋势，但差异无统计学意义（P〉0．05）；3组返流性食管炎的发生率及术后12个月3组各指标比较差异均无统计学意义（P〉0．05）。结论全胃切除术后采用空肠构建贮存袋和保持十二指肠连续性消化道重建并未增加手术复杂性或风险性，由于构建贮存袋与恢复食糜经十二指肠的生理通道，对提高患者的生活质量和降低返流性食管炎并发症有重要意义。FJI型手术方式较Ⅲ型和P型简单，当需要经胸联合切除食管中、下段切除时应选择P型。

Objective To compare the short-term quality of life after total gastrectomy in patients with gastric cancer with three recontructive methods of stamoch storage function. Methods Totally 62 cases underwent jejunal interposition after total gastrectomy from March 2000 to December 2007. Patients were divided into three groups according to the procedures ： functional jejunal interposition （FJI-type） group （ n = 23 ）, modified jejunal interposition （III -type ） group （ n = 20 ）, and P-type jejunal interposition （P-type） group （ n = 19 ）. In each group, the patients＇ general conditions, the nutritional status at month 3 and 12, and gastrointestinal symptoms were evalua- ted. Results The durations of procedures were significantly different among three groups （P 〈 0. 01 ）. The intraop- erative bleeding volume, postoperative complications, and food intake of each meal at month 3 were not significant- ly different （ P 〉 0. 05 ）. Compared with the data at month 3, the levels of hemoglobin and serum calcium at month 12 were significantly higher in all three groups （P 〈 0. 01 ）. Compared to the level at month 3, the level of serum albumin at month 12 significantly increased in FJI-type group （P 〈 0. 05 ） but showed not significant difference in Ⅲ -type group and P-type group （ P 〉 0. 05 ）. The incidence of reflux esophagitis in three groups and the comparative parameters among the three groups at month 12 were not significantly different （ P 〉 0.05）. Conclusions The je- junal interpositions after total gastrectomy will not increase the complexity and risk of the surgical procedure. In fact, they can reduce the reflux esophagitis and improve quality of life by keeping the storage function and restoring food passage through the duodenum. FJI-type is simpler than the other two types, and P-type is preferred for operations that need to open the pectoral cavity.