全胃切除横结肠代胃术在胃癌治疗中的应用

Transverse colon interposition for gastric reservoir following total gastrectomy for gastric cancer

目的:探讨全胃切除横结肠代胃术在胃癌治疗中的应用价值。方法:193例胃癌患者随机分为对照组与观察组,对照组采用传统食管/空肠Schlatter吻合术或食管/空肠Roux-en-Y吻合术重建消化道,观察组以横结肠代胃术重建消化道。比较两组术前、术后第1,9天T细胞亚群和IL-2及急性炎症介质的变化、术后病死率、并发症发生率、住院时间。结果:术前及术后第1天,两组各项指标差异均无统计学意义(均P>0.05);术后第9天,与对照组比较,观察组CD4+细胞比例,CD4+/CD8+,IL-2水平明显升高,而CD8+T细胞比例,IL-6,C-反应蛋白(CRP)水平明显降低(均P<0.05);两组术后病死率、并发症发生率差异无统计学意义(P>0.05),而观察组平均住院时间明显少于对照组(P<0.05)。结论:横结肠代胃术是一种安全的消化道重建新术式,对改善胃癌患者术后的免疫功能具有积极意义。

Objective： To investigate the application value of transposition of a transverse colon segment for gastric replacement after total gastrectomy in treatment of gastric carcinoma. Methods： One hundred and ninety-three gastric cancer patients requiring total gastrectomy were randomly divided into control group and observation group. Patients in control group underwent the conventional Schlatter＇s or Roux-en-Y esophagojejunostomy for digestive tract reconstruction, while those in observation group received gastric reservoir construction of transverse colon transposition after total gastrectomy. The alterations in T-lymphocyte subsets, IL-2 level, and mediators of acute inflammation before operation and at postoperative day （POD） 1 and 9, as well as the mortality, incidence of postoperative complications and length of hospital staybetween the two groups were compared. Results： There were no significant differences between the two groups in all parameters before operation and at POD 1 （all P〉0.05）. At POD 9, the percentage of CD4^＋ T cells, ratio of CD4^＋ to CD8^＋ T cells and IL-2 level in observation group were significantly increased, but the percentage of CD8^＋ T cells and levels of IL-6 and C-reactive protein （CRP） were significantly decreased compared with control group （all P〉0.05）. No differences were noted in postoperative death and incidence of postoperative complications between the two groups （both P〉0.05）, however, the average length of hospital stay in observation group was significantly shorter than that in control group （P〈0.05）. Conclusion： Transverse colon interposition for gastric reservoir is a safe procedure for reconstruction of alimentary tract, which is beneficial for improving the postoperative immune function in gastric cancer patients.