空肠间置术在近端胃癌根治术中的应用

Application of jejunal interposition after radical proximal gastrectomy

目的探讨根治性近侧胃大部切除术后合理的消化道重建方法以及患者对术后辅助化疗的耐受性。方法回顾性分析30例食管残胃问空肠问置组（重建组）和30例食管残胃吻合组（对照组）胃癌患者的手术时间和术后并发症等。分析两组患者术后采用mFOLFOX-6方案辅助化疗的耐受性。结果重建组患者的手术时间为（162．2±14．0）min，对照组为（137．6±18．9）min，差异有统计学意义（P〈0．01）。两组患者术后吻合口瘘、血液感染、导管相关感染、肺部感染情况比较，差异均无统计学意义（均P〉0．05）。两组患者术后第2、4、6天的全身炎症反应综合征发生率和c反应蛋白水平比较，差异均无统计学意义（均P〉0．05）。重建组患者术后第1、3、6个月胃食管反流病的症状评分均低于对照组，差异有统计学意义（均P〈0．05）。重建组患者术后第1、3、6个月体重变化评分均低于对照组，差异有统计学意义（均P〈0．05）。共43例患者接受辅助化疗，其中重建组19例，18例顺利完成I〉6个周期辅助化疗，1例完成5个周期化疗；对照组24例，12例顺利完成≥6个周期辅助化疗，12例完成〈6个周期化疗。两组患者的化疗完成率差异有统计学意义（P〈0．05）。结论空肠间置术手术时问相对延长，术后并发症并未增加，术后烧心反流症状减轻，生活质量明显改善，体重及营养恢复较快，化疗耐受性好，是近端胃癌根治术后较合理的消化道重建方法。

Objective To explore an ideal method of digestive tract reconstruction and tolerance to adjuvant chemotherapy after radical proximal gastrectomy. Methods Thirty patients in the reconstruction group were treated by jejunal interposition, and other 30 patients received gastroesophagostomy （control group）. The operation time, operation risk, occurrence of reflux esophagitis and postoperative 1-, 3-, 6- month nutrition statuses were evaluated. Forty-three patients received postoperative adjuvant chemotherapy with mFOLFOX-6 and tolerance to the chemotherapy was assessed. Results The operation time of the reconstructional group was （ 162.2± 14.0） rain and that of the control group was （ 137.6 ±18.9） mi, with a statistically significant difference. （t = -5.7 ,P 〈 0.01 ）. There were no significant differences of operation risk, postoperative 2-, 4-, and 6-day C-reactive protein, 2-, 4- and 6-day systemic inflammatory response syndrome between the two groups. The differences of the occurrence of postoperative 1-, 3- and 6-month reflux esophagitis and 3- and 6-month nutritional status between the two groups were statistically significant. 18 of 19 （94.7%） patients in the reconstruction group completed all six cycles of chemotherapy ,24 patients in the control group received chemotherapy, and 12 （50.0%） of them completed 6 cycles of chemotherapy. There was a significant difference in the completion rate of chemotherapy of the two groups （ P 〈 0.05 ）. Conclusions The postoperative complications of jejunal interposition are not inceased, the symptoms of reflux esophagitis are alleviated, the quality of life can be improved, and there is a better tolerance to adjuvant chemotherapy. Therefore, jejunal interposition after radical proximal gastrectomy is a rational method of digestive tract reconstruction.