胃癌全胃切除术后3种消化道重建方式的比较研究

Comparetive study on three types of digestive reconstruction after total gastrectomy for gastric cancer

目的:探讨胃癌全胃切除术后理想的消化道重建方式。方法:对191例胃癌患者按全胃切除术后消化道重建方式的不同,分为Roux-en-Y空肠食管吻合术组(R组)、袢式Braun吻合术组(B组)和袢式空肠代胃改良Ⅰ式吻合术组(L组),比较3种术式患者的手术死亡率、术后并发症发生率、进食量、营养指标及存活率。结果:3种术式的患者手术死亡率、术后并发症发生率、3年累积存活率比较差异无统计学意义(P>0.05);与其他2组比较,L组术后6、12个月时单餐进食量明显占优(P<0.05);L组术后1年的平均体重、血清学营养指标及预后营养指数均优于R组和B组,差异有统计学意义(P<0.05)。结论:袢式空肠代胃改良Ⅰ式吻合术能明显改善患者的生活质量,是胃癌行全胃切除消化道重建较理想的术式。

Objective： To investigate the rational digestive reconstruction after total gastrectomy for gastric cancer.Methods： Three types of digestive reconstruction were performed after total gastrectomy in 198 cases with gastric carcinoma.The mortality and morbidity,food intake,body weight,nutritional status and 3 years cumulative survival were compared.Results： There were no significant differences among the three procedures in operative morbidity and mortality,and survival rates of 3 years（P0.05）.Compared to the other two,BraunⅠ-type（Group L） had a better food intake at 6 and 12 months after surgery（P0.05）.BraunⅠ-type had better nutritional status（Body weight,albumin,hemoglobin and PNI） than Roux-type（Group R） and Braun-type（Group B） at 12 months after surgery（P0.05）.Conclution： BraunⅠ-type esophagojejunostomy can be recommended as an adoptable method of digestive reconstruction after total gastrectomy for gastric carcinoma because of maintaining better nutritional status and quality of life.