远端胃次全切除术后不同消化道重建方式的实验观察

Different procedures of alimentary tract reconstruction after subtotal distal gastrectomy in dogs

目的 探讨远端胃次全切除术后合理的消化道重建方式.方法 将32只Beagle犬以随机数字表法分为4组（实验组A、B、C和对照组）,每组8只.A、B、C组远端胃次全切除术后分别行残胃-十二指肠-连续性空肠间置、毕Ⅱ式、Roux-en-Y式消化道重建,对照组施以假手术.术后连续观察12周,比较各组手术前后摄食、体重、预后营养指数（PNI）和外周血Ghrelin浓度的变化.结果 A、B、C组术后摄食量、体重及PNI均较术前下降,然后缓慢回升,术后12周,A组摄食量、体重及PNI（26.8±3.3）均优于B组（25.4±3.0）和C组（25.6±3.0）,差异有统计学意义（P＜0.05）,而B、C组间比较差异无统计学意义.A、B、C组术后第1天外周血Ghrelin浓度均较术前明显下降,1周后,Ghrelin浓度开始回升,术后12周,A组Ghrelin浓度[（280±15）pg/ml]明显高于B组[（180±10）pg/ml]和C组[（185±10）pg/ml,均P＜0.05）].对照组手术前后食量、PNI及血Ghrelin浓度无明显变化（P＞0.05）,术后12周后体重明显高于术前（P＜0.05）.结论 远端胃次全切除术后,残胃-十二指肠-连续性空肠间置术恢复了十二指肠生理通道,术后摄食量、体重及PNI恢复更快、促食激素Ghrelin代偿性分泌更明显,为一种较理想的重建术式.

Objective To explore an ideal procedure of alimentary tract reconstructions after subtotal distal gastrectomy. Methods Thirty-two healthy adult beagle dogs were randomly divided into experimental groups A, B, C and control group （n= 8）. Groups A, B, C operated by subtotal distal gastrectomy underwent 3 different reconstruction methods： continual jejunal interposition （CJI）, Billroth Ⅱ and Roux-en-Y. The control group received a sham operation. Dogs were observed for 12 weeks postoperation. The different parameters of body weight, food intake, PNI （prognostic nutritional index） and peripheral blood concentration of ghrelin were measured in 4 groups. Results The body weight, food intake and PNI in Groups A, B, C decreased significantly at post-operation versus pre-operation. There was a slow elevation of body weight, food intake and PNI at Week 12. Group A was significantly better than Groups B and C （P 〈 0. 05） while there was no significant difference between Groups B and C. The plasma ghrelin concentrations in Groups A, B, C were significantly reduced at Day 1 post-operation versus pre-operation.But no difference was observed among Groups A, B and C. However an elevated ghrelin concentration was observed at Week 1 post-operation. At Week 12 post-operation, the plasma ghrelin concentration in Group A increased significantly versus Groups B and C （both P 〈0. 05）. However, the plasma ghrelin concentration,food intake and PNI were not significantly changed in control group （P 〉 0. 05）. Conclusions The CJI reconstruction procedure is ideally suited for the preservation of duodenal passage after subtotal distal gastrectomy. Subsequently it leads to a significant elevation of circulating ghrelin concentration and a rapid post-operative recovery of food intake, body weight and PNI.