全胃切除术后消化道重建方式的比较

Comparative study on digestive reconstruction after total gastrectomy

目的探讨全胃切除术后合理的消化道重建方式。方法对121例胃癌患者全胃切除术分别采用食管空肠Roux—en—Y吻合术（R组）、P形空肠袢食管空肠Roux-en—Y吻合术（PR组）、P型空肠间置食管术（PI组）三种不同方法进行消化道重建，对其手术时间、并发症、术后饮食状况、消化道症状及营养指标进行对比观察。结果PI组预后营养指数（PNI）为50．1，分别高于PR组的42．6及R组的40．3（x2=3．984、3．911，均P〈0．05）；PR组出现胃潴留综合征6例（14．3％），明显高于R组的2例（5．0％）（x2=4．235，P〈0．01）；R组反流性食管炎高于PR组和PI组（x2=4．125、4．135，均P〈0．01）；三种消化道重建术后半年血浆蛋白及体质量下降情况差异均无统计学意义（均P〉0．05）。R组1、3、5个月累计生存率分别为88．1％、45．0％、23．4％；PR组分别为85．4％、43．1％、21．3％，PI组分别为85．1％、42．3％、21．3％，三组之间差异无统计学意义。结论食管空肠Roux—en—Y吻合、P型空肠袢代胃术是全胃切除术后消化道重建较为合适的方式。

Objective To explore the type of the rational digestive reconstruction after total gastrectomy for gastric malignancy. Methods Three types of digestive reconstruction were performed after total gastrectomy in 121 cases with gastric carcinoma. The operating time, morbidity and mortality, digestive tract symptoms, nutritional status in 1 year after operation were compared. Results There were no significant differences among the three prgcedures in operative morbidity and mortality, postoperative food intake, nutritional status, incidences of diarrhea and dumping syn- drome. Roux-en-Y esophajejunostomy and P-type esophajejunostomy had an advantage of anti-esophageal reflux, and are obviously superior to Lahey ＋ Braun anastomosis. Roux-en-Y esophajejunostomy was simpler with shorter operating time and less complication. Conclusion Roux-en-Y esophajejunostomy and P-type esophajejunostomy could be rec- ommended as suitable methods for digestive reconstruction after total gastrectomy.