全胃切除术后恢复十二指肠路径P型和功能性空肠间置代胃消化道重建术对患者远期营养状况的影响

Impacts of jejunal P pouch reconstruction and functional jejunal interposition in reconstructed duodenal food passage after total gastrectomy on long-term nutritional status

目的比较全胃切除术后P型空肠间置代胃和功能性空肠间置代胃（FJI）两种恢复食物经十二指肠路径的消化道重建方式对患者远期营养状况和生活质量的影响。方法2003年1月至2011年6月，50例胃癌患者在东华医院行全胃切除术，其中27例行P型空肠问置代胃消化道重建术，23例行FJI消化道重建术。术后第1天至第7天予以全肠外营养支持。观察患者围术期并发症情况。术后6个月和12个月分别监测两组患者体重、血清总蛋白、血清白蛋白、血红蛋白和反流性食管炎发生情况，计算营养评定指数（NAI）。结果50例患者均未发生严重手术并发症，无围术期及化疗相关死亡。术后6个月P型组和FJI组的体重减轻量[（3．67±0．91）kg比（3．44±0．52）kg，P=0．28]、血清总蛋白[（52．62±1．67）g／L比（53．22±1．24）g/L，，P=0．16]、血清白蛋白[（31．26±1．29）g／L比（30．70±2．41）g／L，P=0．32]、血红蛋白[（118．01±5．96）g／L比（117．83±6．72）g/L，P=0．92]、NAI（P=0．39）和反流性食管炎发生率（11．1％比13．O％，P=1．00）差异无统计学意义。术后12个月两组的体重减轻量[（2．71±0．45）kg比（2．74±0．42）kg，P=0．77]、血清总蛋白[（53．93±1．66）g／，L比（53．34±1．84）g,／L，P=0．24]、血清白蛋白[（32．60±1．42）g,／L比（30．76±2．10）g／L，P=0．23]、血红蛋白[（124．18±6．56）g／L比（119．99±6．13）g／L，P=0．16]、NAI（P=0．43）和反流性食管炎发生率（7．4％比8．7％，P=1．00）差异无统计学意义。结论全胃切除术后P型和FJI这两种消化道重建方式对患者术后远期营养状况和生活质量的影响无差异。

Objective To compare the long-term nutritional status and quality of life after jejunal P pouch reconstruction and functional jejunal interposition （FJI） in reconstructed duodenal food passage after to- tal gastrectomy. Methods Of 50 patients with gastric cancer who received total gastrectomy in Donghua Hospi- tal between January 2003 and June 2011,27 received jejunal P pouch reconstruction and 23 underwent FJI. All the patients were given total parenteral nutrition from the first to the seventh postoperative day, and the periop- erative complications were observed. The body weight, serum total protein, serum albumin, and hemoglobin were measured 6 and 12 months after surgery, and the nutritional assessment index （NAI） was calculated. Results No serious complications occurred in any of the cases, and no surgery- or chemotherapy-related death was noted. Six months after the surgery, the body weight loss[ （3.67±0.91） kg vs. （3.44±0.52） kg, P =0. 28], serum total protein [ （52. 62 ±1.67） g/L vs. （53.22 ± 1.24） g/L, P =0. 16], serum albumin [（31.26±1.29） g/L vs. （30.70 ＋2.41） g/L, P =0.32], hemoglobin [（118.01 ±5.96） g/L vs. （ 117.83±6. 72） g/L, P =0.92], NAI （P =0. 39）, and reflux esophagitis incidence （11.1% vs. 13.0%, P = 1.00） showed no significant difference between these 2 groups. Twelve months after the surgery, the body weight loss [（2.71± 0.45） kg vs. （2.74 ± 0.42） kg, P = 0.77], serum total protein [（53.93 ± 1.66） g/Lvs. （53.34 ± 1.84） g/L, P =0.24], serum albumin [（32.60± 1.42） g/L vs. （30.76 ± 2.10） g/L, P=0.23], hemoglobin [（124. 18 ±6.56） g/Lvs. （119.99 ±6. 13） g/L, P=0.16], NAI （P =0. 43）, and reflux esophagitis incidence （7.4% vs. 8.7%, P = 1.00） were also not significantly differ- ent between the 2 groups. Conehmion The impacts on long-term nutritional status and quality of life are similar between jejunal P pouch reconstruction and FJI in reconstructed duodenal food passage after total gastrectomy.