3S型与P袢型空肠代胃在全胃切除后消化道重建中的应用比较

Comparative study on two types of 3S and P-loops digestive reconstruction after total gastrectomy for gastric cancer

目的比较3S型空肠代胃和P袢型空肠代胃在全胃切除术消化道重建中的临床作用．方法2005年2月至2009年2月间河南科技大学附属第一医院肿瘤科进行全胃切除术85例，其中46例采用3S型空肠代胃、39例P袢型食管空肠Roux—en—Y吻合进行消化道重建，比较两种重建术后6个月的并发症发生情况、营养状况及生活质量。结果两种消化道重建方式手术时间、围手术期并发症发生率及病死率的差异均无统计学意义（P〉0．05）。术后6个月，与P袢型空肠代胃组患者相比。3S型空肠代胃组患者倾倒综合征[4．3％（2／46）比10．3％（4／39）]和反流性食管炎[10．8％（5／46）比33．3％（13／39）]的发生率均更低，总蛋白[（55．7±3．1）g／L比（50．3±5．1）g／L]、白蛋白[（36．5±3．6）g／L比（31．6±4．4）g／L]、血红蛋白[（120．2±13．4）g／L比（110．4±23．0）g／L]及营养评定指数（73．2±4．8比56．0±6．3）均更高。生活质量（Cuschieri分级）更优，差异均有统计学意义（均P〈0．05）。结论3S型空肠代胃术这一消化道重建方式能有效防止反流性食管炎及倾倒综合征的发生．改善患者的营养状况，提高术后生活质量。

Objective To compare the clinical effect of 3S-type and P-loops digestive reconstruction after total gastrectomy for gastric cancer. Methods From Februray 2005 to Februray 2009, 85 cases underwent total gastrectomy in The First Affiliated Hospital of Henan University of Science and Technology. Two types of digestive reconstructionwere performed with 3S-type jejunum （n=46） and P-loops Roux-en-Y esophagojejunostomy （n=39）. The postoperative complications, nutrition index and the quality of life at half a year after surgery were comparatively analyzed. Results Two types of digestive reconstruction had no statistical differences in operative time, postoperative complications and mortality （P〉0.05）. Compared with P-loops Roux-en-Y esophagojejunostomy at 6 months after operation, 3S-type jejunum had a lower incidence in dumping syndrome [4.3% （2/46） vs. 10.3% （4/39）, P〈0.05] and reflux esophagitis [10.8% （5/46） vs. 33.3% （13/39）, P〈0.05]. 3S-type jejunum was superior to P-loops Ronx-en-Y esophagojejunostomy in serum total protein （55.7±3.1 g/L vs 50.3±5.1 g/L, P〈0.05）, albumin （36.5±3.6 g/L vs. 31.6±4.4 g/L, P〈0.05）, hemoglobin （120.2±13.4 g/L vs. 110.4±23.0 g/L, P〈0.05）, and nutritional assessment index（73.2±4.8 vs. 56.0±6.3, P〈0.05）. Conclusion Reconstruction of stomach with 3S-type jejunum may be an effective way to prevent reflux esophagitis and dumping syndrome, and to improve the nutritional status and the quality of life.