胃全切术后Roux-en-Y术与空肠间置代胃术行肠道重建的价值

Value of intestinal tract reconstruction by Roux-en-Y and jejunal nterposition after total gastric resection

目的探讨胃全切术后Roux-en-Y术与空肠间置代胃术行胃肠道重建的临床价值。方法选择60例患者,随机分为两组,每组各30例,Roux-en-Y组实施Roux-en-Y术式,空肠间置代胃组使用空肠间置代胃术,对所有患者随访2年,比较两组患者术后1年营养状态及随访2年的并发症。结果空肠间置代胃组术后1年期白蛋白、血红蛋白及体重均未较术前有显著变化(P>0.05),且均高于Roux-en-Y组(P<0.05),Roux-en-Y组术后1年期白蛋白、血红蛋白及体重均低于术前(P<0.05),空肠间置代胃组发生饱胀、食欲减退、腹泻和反流性食管炎的比率均显著低于Roux-en-Y组(P<0.05)。结论空肠间置代胃术有效保留了肠道尤其是十二指肠的功能,对于保证消化道正常功能、提高患者术后营养意义重大,且能减少术后并发症,是一种相对理想的手术方式。

Objective To investigate the clinical value of intestinal tract reconstruction by Roux-en-Y and jejunal nterposition after total gastric resection. Methods 60 cases were selected and randomly divided into two groups,with 30 cases in each group.Patients in Roux-en-Y group were given operation of Roux-en-Y,and patients in jejunal nterposi- tion group were given operation of jejunal nterposition.All the patients were followed up for 2 years,and comparison be- tween two groups was conducted on nutritional status in 1 year after operation and complications occurred in follow-up period for 2 years. Results In jejunal nterposition group,albumin,hemoglobin and weight in 1 year after operation had no significant change compared with that before operation （P〉0.05）.And they were higher than that in Roux-en-Y group （P〈O.OS）.Albumin,hemoglobin and weight in 1 year after operation in Roux-en-Y group were lower than that be- fore operation （P〈0.05）.The incidence rate of flatulence,anorexia,diarrhea and reflux esophagitis in jejunal nterposition group were significantly lower than that in Roux-en-Y group （P〈0.05）. Conclusion Jejunal nterposition effectively re- tain the function of intestinal tract,especially the duodenum.h has a great significance in ensuring the normal function of digestive tract and improving postoperative nutrition of patients.And it can reduce postoperative complications.So it is a relatively ideal surgery.