远端胃大部切除术后连续性空肠间置的实验研究

Experimental research of integral continuous jejunal interposition after subtotal distal gastrectomy

目的 评估远端胃大部分切除术后连续空肠间置对比格犬术后的营养状况、肌电活动及胃肠道排空的影响.方法 对30只比格犬行远端胃大部分切除术,通过连续空肠间置（连续间置组,9只）、毕Ⅰ式吻合（毕Ⅰ组,6只）、毕Ⅱ式吻合（毕Ⅱ组,7只）和孤立间置（孤立间置组,8只）4种不同方式进行消化道重建,比较术后4组实验犬的体质量、血常规、肝功能、肌电活动及胃肠道排空时间.结果 术后12周,连续间置组实验犬体质量为（9.65±1.54）kg,明显高于其他3组[毕Ⅰ组（9.25±1.76）kg,毕Ⅱ组（9.31±1.54）kg,孤立间置组（7.77±1.46）kg,均P＜0.05].术后4周,连续间置组实验犬预后营养指数为2671.9±49.9,明显高于孤立间置组（2440.9±54.3,P＜0.05）和毕Ⅱ组（2555.9±54.7,P＜0.05）,但与毕Ⅰ组（2791.8±54.3）比较,差异则无统计学意义（P＞0.05）.术后6周,连续间置组空腹及餐后空肠起搏频率均显著高于毕Ⅱ组和孤立间置组（P＜0.05）,但与毕Ⅰ组比较差异无统计学意义（P＞0.05）;连续间置组空腹及餐后反口方向起搏频率则显著高于其他3组（P＜0.05）.连续间置组、毕Ⅰ组、毕Ⅱ组和孤立间置组食物排空率分别为95.4%、91.3%、93.1%和94.2%,差异无统计学意义（P＞0.05）.然而,与毕Ⅰ组和毕Ⅱ组比较,连续间置组手术时间更长、术后腹腔粘连更重、恢复正常饮食时间更慢（均P＜0.05）.结论 对于远端胃大部切除术后不能行毕Ⅰ式吻合重建者,可优先考虑连续性空肠间置.

Objective To evaluate nutritional status, myoelectrical activity, and gastrointestinal tract emptying capacity after integral continuous jejunal interposition following subtotal gastrectomy.Methods According to different re-construction techniques, 30 Beagle dogs were divided into four groups after subtotal distal gastrectomy： group 1 （n=9, integral continuous jejunal interposition）, group 2 （n=6, Billroth Ⅰ ）, group 3（n=7, Billroth Ⅱ ）, group 4（n=8, isolated jejunal interposition）. Blood cell counts, liver function, myoelectrical activity and the rate of gastrointestinal tract emptying were compared among the four groups. Results At week 12 after operation, the body weight in group 1 [（9.65±1.54） kg]was significantly higher than that in group 2 [（9.25±1.76） kg], group 3 [（9.31±1.54） kg]and group 4 [（7.77±1.46） kg]. At week 4, the prognostic nutritional index in group 1 （2671.9±49.9） was significantly higher than that in group 3 （2555.9±54.7） and group 4 （2440.9±54.3）, but similar to that in group 2（2791.8±54.3）. At week 6, the fasting and postprandial frequency of jejunal pacesetter potentials in group 1 were higher than those in group 3 and group 4 （P〈0.05） but comparable with those in group 2. The emptying rate of food in the four groups were 95.4%,91.3%, 93.1% and 94.2%, respectively and there were no significant differences （P〉0.05）. However,as compared with group 2 and group 3, group 1 had longer operative time and later regular diet resumption, more severe abdominal adhesion （P〈0.05）. Conclusion Continuous jejunal interposition should be considered when Billroth Ⅰ is not feasible after subtotal gastrectomy.