胃癌全胃切除术不同消化道重建方式患者血清铜的变化

Changes of serum copper in patients with different digestive tract reconstruction after total gastrectomy for gastric cancer

目的探讨全胃切除术不同消化道重建方式对胃癌患者血清铜的影响。方法选择2012年6月至2015年6月行全胃切除的70例胃癌患者作为研究对象,采用信封法将患者随机分为实验组和对照组,实验组采用调节型双通道空肠间置代胃术(40例),对照组采用RY重建术(Roux-en-Y,30例),测量患者术前、术后2年血常规及血清铜、锌、维生素B12水平,并对患者进行神经系统体格检查。结果手术均顺利完成。术后2年复查,两组各1例失访,实验组和对照组获随访39例和29例。部分患者发生了低铜血症伴其相关并发症,实验组1例(2. 56%),对照组6例(20. 69%),采用RY重建术的对照组低铜血症发生率明显高于采用调节型双通道空肠间置代胃术的实验组(χ2=4. 121,P <0. 05)。结论胃癌全胃切除术是发生低铜血症的危险因素,调节型双通道空肠间置代胃术与Roux-en-Y重建术相比,发生低铜血症及其相关并发症几率更低。

Objective To investigate the effects of different digestive tract reconstruction methods on serum copper after total gastrectomy in patients with gastric cancer. Methods Seventy patients with gastric cancer who underwent total gastrectomy from June 2012 to June 2015 were selected,and randomly divided into experimental group( n = 40) and control group( n = 30) by envelope method. The adjustable double-channel jejunal interposition( a-DJI) was performed in experimental group and RY reconstruction( Roux-en-Y) surgery was conducted in control group. Blood routine and serum levels of copper,zinc and vitamin B12 were detected before and 2 years after operation,and physical examination of nervous system was performed in all patients. Results The operation was successfully completed in both groups. During 2-year postoperative period,one case was lost to follow-up in each group. Hypocupremia and related complications occurred in some patients,and there were one case in experimental group( 2. 56%) and six cases in control group( 20. 69%). The incidence of Hypocupremia in control group was significantly higher than that in experimental group( χ^2= 4. 121,P <0. 05). Conclusions Total gastrectomy is a risk factor for Hypocupremia in patients with gastric cancer. Compared with Roux-en-Y reconstruction,adjustable double-channel jejunal interposition has lower incidence of Hypocupremia and its related complications.