胃癌根治性全胃切除消化道重建方式的选择

Comparison of three reconstructive techniques after total gastrectomy for gastric cancer

目的 探讨胃癌根治性全胃切除术后合理的消化道重建方式.方法 对136例胃癌行根治性全胃切除患者病例资料回顾性分析,对比全胃切除后食管空肠袢式吻合（袢式）、食管空肠Roux-en-Y式吻合（RY）及食管空肠P袢Roux-en-Y式吻合（P袢）三种消化道重建方式的重建时间、围手术并发症、消化道症状、饮食、营养状况.结果 三组术后3个月、6个月、9个月时,患者单餐进食量,体重、血浆总蛋白、白蛋白较术前变化值各组间差异无统计学意义,RY与P袢方式抗反流效果优于袢式,RY重建平均用时（22±9） min,少于袢式（36±6） min及P袢式（29±7） min,操作最简便易行.结论 食管空肠Roux-en-Y式吻合是胃癌根治性全胃切除后一种相对较好的消化道重建方式.

Objective To discuss the advantage of three reconstructive techniques aiter total gastrectomy for gastric cancer. Methods The clinical data of 136 cases undergoing total gastrectomy were analyzed retrospectively. Three reconstructive techniques were involved. The reconstructive time, peri-operative complications, digestive symptoms, food intake and nutrition status post-opera- tion were considered. Results There was no significant difference in peri-operative complications, food intake and nutrition status post-operation. RY and P-loop-RY had better outcomes at anti-reflux esophagitis than Moynihan＇s procedure. RY was the simplest procedure among three techniques. Conclusion RY esophagojejunostomy is a reasonable reconstruction after total gasrectomy for gastric cancer.