非离断式Roux—en—Y远端空肠储袋代胃术在全胃切除消化道重建中的应用

The application of uncut Roux-en-Y esophagojejunostomy with distal jejunal pouch on behalf of the stomach surgery in the digestive tract reconstruction after total gastrectomy

目的研究非离断式Roux—en—Y远端空肠储袋代胃术（URYAJP）在全胃切除术后消化道重建中的临床应用价值。方法回顾性分析行全胃根治性切除术的486例胃癌患者的临床资料，根据消化道重建方式分为储袋代胃术组（URYAJP组，189例）、P袢Roux—en-Y代胃术（PRY组，150例）和单纯Roux—en-Y重建术（RY组，147例）。比较3组患者的手术重建时间、术后并发症的发生情况、术后6、12、24个月的体质量、单餐进食量和预后营养指数（PNI）及术后12、24个月Visck分级情况。结果（1）URYAJP组和PY组消化道重建时间分别为（37±6）min和（38±6）min，PRY组明显延长[（47±6）min，t=7．52、6．54，P〈0．05]。（2）URYAJP组Roux潴留综合征发生率为2．1％，明显低于PRY组（21．3％，x2=16．57）和RY组（19．7％，x2=14．84），差异均有统计学意义（P〈0．05）。（3）术后12个月时，URYAJP组体质量下降程度较轻[（3．1±1．0）kg，t=25．03、22．99，P〈0．05]；术后12、24个月时单餐进食量达到术前水平的94．8％和96．9％，而PRY组和RY组均不足50％，差异均有统计学意义（x2=61．10、69．17、65．17、73．29，P〈0．05）；术后24个月时URYAJP组PNI指数（47．1±5．2）逐步恢复至术前水平（47．3±5．1），而PRY组（42．3±4．1）和RY组（42．5±4．2）仍低于术前（x2=106．97、100．37，P〈0．05）。（4）术后12、24个月A组VisickI～Ⅱ级分别为92．7％和93．8％，明显优于PRY组和RY组（x2=10．63、14．19、10．10、10．74，P〈0．05）。结论URYAJP充分发挥了保持肠道连续性、手术简单和建立食物储袋的优势，可以减少术后远期并发症、改善患者营养状况和提高生活质量，是临床上值得推广的一种消化道重建方式。

Objective To study the clinical value of uncut Roux-en-Y esophagojejunostomy with distal jejunal pouch on behalf of the stomach （URYAJP） surgery in the digestive tract reconstruction after total gastrectomy. Methods A retrospective analysis of radical resection of the whole stomach in 486 cases of gastric cancer patients, divided into the URYAJP group （ n = 189 ）, the P-loop Roux-en-Y behalf of the stomach surgery （PRY） group （ n = 150） and pure Roux-en-Y reconstruction （RY） group （ n = 147 ）. Three groups were compared in patients with surgical reconstruction time, the occurrence of postoperative complications, the postoperative weight after 6, 12 and 24 months, the single meal food intake and prognostic nutritional index （PNI） and Visick points class situation after 12 and 24 months. Results （ 1 ） The URYAJP group and RY group had no significant difference in digestive tract reconstruction time （ （37± 6） minutes and （38 ＋ ±6） minutes respectively）, but PRY group was significantly prolonged （（47 ± 6） minutes, t = 7. 52 and 6. 54, P 〈 0. 05）. （2） In the comparison of the incidence of complications, URYAJP group has 2. 1% rate of Roux stay syndrome （RSS） incidence, significantly less than PRY group （21.3%） and RY group （ 19. 7% ） （ x2 = 14. 84, P 〈 0. 05 ）. （3） In the comparison the postoperative nutritional status, URYAJP group clear asset, showing the degree of （ （3. 1± 1.0） kg） weight loss after 12 months （t =25.03 and 22. 99, P 〈0. 05）. And after 12, 24 months, a single meal eating reached the preoperative level is 94. 8% and 96.9% in URYAJP group, while PRY group and RY group is less than 50% （ X2 = 61.10, 69. 17, 65.17 and 73.29, P 〈 0. 05 ）. URYAJP Group reach the preoperative levels of PNI in 24 months after surgery, while PRY and RY group were still lower than peroperation （ t = 106. 97 and 100. 37, P 〈0. 05）. （4） The Visick points class I- II postoperative 12 and 24 months in URYAJP group were 92.7% and 93.8% , significantly better than group B and C （ X2 = 10. 63, 14. 19,10. 10 and 10. 74, P 〈 0.05 ）. Conclusions URYAJP surgery give full play to maintain intestinal continuity, simple operation, and advantages of food storage bags, it can reduce the long-term postoperative complications, improve the nutritional status of patients and improve quality of life. It is worthy of promoting a way of gastrointestinal reconstruction.