全胃切除术后两种消化道重建术的效果比较

Comparison of the effect between two methods of digestive tract reconstruction after gastrectomy

目的比较改良袢式空肠代胃术与P型空肠代胃术的优缺点及临床应用价值。方法56例胃癌患者依据胃切除术后消化道重建方式分为两组，观察组35例采取改良袢式空肠代胃术；对照组21例采取P型空肠代胃术，比较两组临床效果。结果两组手术时间和术中出血量差异无统计学意义（P〉0．05）。观察组排空时间[（61±23）min]较对照组[（37±19）min]长（t=3．03，P〈0．05），每次饮食量[（308±44）m1]较对照组[（262±34）m1]高（t：2．55，P〈0．05），每天饮食次数[（4．2±1．2）次]较对照组[（5．7±2．3）次]少（t=2．46，P〈0．05）。观察组术后并发症发生率（14．3％）显著低于对照组（42．9％）（χ2=5．71，P〈0．05）。结论全胃切除术后，采用改良袢式空肠代胃术重建消化道，相对于P型空肠代胃术，能有效提高患者术后生活质量，降低并发症发生率，但并未使手术过程复杂化。

Objective To compare the advantages, disadvantages and clinical value of the improved loop the jejunum behalf of the stomach surgery and the P - type jejunum on behalf of stomach surgery. Methods 56 patients with gastric cancer were divided into two groups by different ways of gastrectomy alimentary tract after gartrectomy. Patients in observation group（ n = 35 ） were given the modified loop jejunum on behalf of gastric surgery and patients in control group（ n = 31 ） received P-type jejunum on behalf of the stomach surgery. The clinical effects were compared between two groups. Results There were no significant differences in surgical time and bleeding volume in 2 groups （ P 〉 0.05 ）. Emptying time [ （ 61±3 ） min] of observation group was longer than that of control group （ 37 ± 19 ） min] （ t = 3.03, P 〈 0. 05 ） ; Each food intake [ （ 308 ± 44 ） ml ] in observation group was significiantly improved compared with control group [ （ 262±34） ml （ t = 2.55, P 〈 0.05 ） ; The times of daily diet [ （ 4.2 ± 1.2 ） times ] in observation group was lower than that of control group [ （ 5.7 ± 2.3 ） ] （ t = 2.46, P 〈 0.05 ）. The incidence of postoperative com- plications（ 14.3% ） of the observation group was significantly lower than the control group （42.9%） （χ2 = 5.71, P 〈 0.05）. Conclusion On the terms of 2 ways of digestive tract reconstruction, the improved loop the jejunum be- half of the stomach surgery is superior to the P-type jejunum on behalf of the stomach surgery, which can effectively improve the quality of life of patients and reduce the incidence of complications, but have no complex surgical proce- dures.