胃癌近端胃大部切除术消化道重建方式的临床观察

Reconstructive approaches of alimentary canal for subtotal gastrectomy

目的 探讨近端胃癌根治术中合理的消化道重建方式,以提高患者的生存质量.方法 回顾性分析我院2000至2009年,120例手术治疗的近端胃癌患者的临床资料,所有患者皆行近端胃癌根治术,其中包括3种消化道重建方式：食管胃前壁吻合组50例,间置空肠组26例,管状胃组44例,比较并分析3组术后生活质量的差异.结果 管状胃组烧心症状、反流性食管炎评分高于其他两组（Ⅲ级评分分别为6、3、27和6、6、27）,吻合口瘘、吻合口狭窄发生率（18.2%）明显高于其他两组（4.0%、3.8%）,而患者血红蛋白增加值、体重增加值小于其他两组（P＜0.05）;在实验中120 min以及180 min胃排空百分数,管状胃组与食管胃前壁吻合组比较差异无统计学意义（P＞0.05）,但高于间置空肠组（P＜0.05）;食管胃前壁吻合组与间置空肠组各个指标差异,差异均无统计学意义（均P＞0.05）.结论 近端胃癌手术中胃前壁食管侧端吻合对于近端胃癌来说是一种良好的消化道重建方式,可以使患者的术后生活质量得到明显改善.

Objective To explore the optimal technique of digestive tract reconstruction for radical proximal gastrectomy. Methods The clinical data for 120 cases of proximal gastric cancer undergoing radical proximal gastrectomy at our hospital from 2000 to 2009 were analyzed retrospectively. They included three approaches of digestive tract reconstruction. The patients were divided into esophagogastric anterior wall anastomosis group （ n = 50 ）, jejunal interposition group （ n = 26 ） and gastric tube group （ n = 44 ）. The quality of life was evaluated and compared among 3 groups. Results The rates of anastomotic fistula,anastomotic obstruction and the scores of heart burn and reflux esophagitis were higher in gastric tube group.And the increments of hemoglobin and body weight were less in gastric tube group than those in other groups （P ＜ 0. 05 ）. The rates of gastric emptying in gastric tube group had no obvious differences with esophagogastric anterior wall anastomosis group at 120 min and 180 min （ P ＞ 0. 05 ）. And they were higher than those in jejunal interposition group （ P ＜ 0. 05 ）. There was no statistical difference in any parameter between esophagogastric anterior wall anastomosis and jejunal interposition groups （ P ＞ 0. 05 ）. Conclusion The anastomosis of esophagogastric anterior wall is an ideal approach of digestive reconstruction for radical proximal gastrectomy. And it may improve the quality of life for surgical patients with proximal gastric cancer.