全胃切除术后四种消化道重建方式的对照研究(英文)

Comparison of Four Digestive Tract Reconstruction Methods for Total Gastrectomy

目的:全胃切除术后常常会发生明显的营养不良、各种术后不良症状以及生活质量的下降。本研究通过对比全胃切除术后四种消化道重建方式,探讨全胃切除术后理想的消化道重建术式。方法:选取自2007年11月至2011年3月间我院行全胃切除术治疗胃癌患者196例,分为A组(行功能性空肠间置代胃术)、B组(P型空肠间置代胃术)、C组(P型Roux-en-Y空肠代胃术)、D组(改良Longmire法空肠代胃术)4种消化道重建术。比较4组患者手术时间、出血量、住院时间和死亡率以及术后1年生活质量、营养状况和术后并发症情况。结果:4组患者在平均手术时间、出血量、住院时间和死亡率方面无明显差异(P>0.05)。A组患者倾倒综合征、反流性食管炎、Roux-en-Y滞留综合征发生率分别为2.1%(1/48)、4.2%(2/48)和2.1%(1/48),均显著低于其他3组(均P<0.05)。术后1年生活质量(Visick分级指数)的比较,A组明显优于其他3组(均P<0.05)。术后1年营养预后指数(PNI)分别为55.40±3.6,52.30±2.8,41.5±4.3和40.7±5.5,A组和B组明显高于C组和D组(P<0.05),A组和B组组间数据差异无统计学意义(P>0.05),C组和D组组间数据差异无统计学意义(P>0.05)。结论:全胃切除术术后消化道重建应保持空肠的连续性并保持摄入食物通过十二指肠。功能性空肠间置代胃术安全可靠,对于减少全胃切除术后并发症的发生率,提高生活质量和营养状况有着重要的意义。

Objective： To investigate the optimum digestive tract reconstruction after total gastrectomy by comparing four types of reconstructions. Methods： 196 patients with gastric cancer undergoing total gastrectomy in Liaoning Cancer Hospital ＆ Institute between November 2007 and March 2011 were divided into 4 groups according to the type of reconstruction： group A （continual jejunal interposi- tion, n=48）, group B （P pouch with jejunal interposition, n=39）, group C （P pouch with Roux-en-Y esophagojejunostomy, n=66） and group D （modified Longmire esophagojejunostomy, n=43）. The following data were contemporaneously recorded： operating time, esti-mated blood loss, length of hospital stay and the mortality. The quality of life, nutritional status 12 months after surgery, and postopera-tive complications were analyzed. Results： The mean operating time, blood loss, hospital stay and mortality did not significantly differ in the 4 groups （P〉0.05）. The incidences of dumping syndrome, reflux esophagitis and Roux-en-Y stasis syndrome in group A were 2.1% （1/48）, 4.2 % （2/48） and 2.1% （1/48）, respectively, which were significantly lower than those in other groups （P〈0.05）. One year after operation, the quality of life （Visick Index） was better in group A than those in other groups （P〈0.05）. The Prognostic Nutrition Index （PNI） of the 4 groups were 55.40±3.6, 52.30±2.8, 41.5± 4.3 and 40.7± 5.5, respectively. The PNIs in group A and B were better than those in group C and D （P〈0.05）. Conclusion： It is essential to maintain the continuity of jejunal function and the digestive tract flowing through the duodenum after total gastrectomy. Total gastrectomy with continual jejunal interposition is safe, and offers better nutritional status, quality of life and a greater reduction in postgastrectomy symptoms than others.