改良袢型、3S型与P袢型空肠代胃在胃癌全胃切除术后消化道重建中的随机对照研究

Comparative Study on Three Types of Improved P-loops,3S and P-loops Digestive Reconstruction after Total Gastrectomy for Gastric Cancer

目的比较改良袢型、3S型与P袢型空肠代胃在胃癌全胃切除术消化道重建中的临床疗效。方法2005年2月至2010年11月我院进行全胃切术的胃癌和贲门腺癌病人共131例,入院完善术前检查后随机分为3组,其中43例采用改良袢型,47例3S型空肠代胃,41例P袢型空肠代胃吻合进行消化道重建,比较3种重建术后并发症、营养状况及生活质量。结果 3种消化道重建方式手术时间、围手术期并发症发生率及病死率的差异均无统计学意义(P>0.05),术后改良袢型组和S型这两组患者与P袢型空肠代胃组患者相比,前二者倾倒综合征和反流性食管炎的发生率更低,且前两者之间对比差别不大;术后饮食较术前无明显改变;总蛋白、白蛋白、血红蛋白及营养评定指数均高于P袢型空肠代胃组,差异均有统计学意义(P<0.05)。结论改良袢型与3S型一样能有效防止倾倒综合征和反流性食管炎的发生,改善患者的营养状况,提高术后生活质量。

Objective To compare the clinical effect of types of improved P-loops, 3S and P-loops digestive reconstruction after total gastrectomy for gastric cancer. Methods Form February 2005 to November 2010, 131 cases underwent total gastrectomy in the First Affiliated Hospital of Henan University of Science and Technology. Three types of digestive reconstruction were performed with 3S-type jejunum （n = 47）, improved P-loops jejunum （ n = 43 ） and P-loops Roux-en-Y esophagojejunostomy （ n = 41 ）. The postoperative complications, nutrition index and the quality of life after surgery were comparatively analyzed. Results Three types of digestive reconstruction had no statistical differences in operative time, postoperative complications and mortality （P 〉 0. 05 ）. Compared with P-loops Roux-en-Y esophagojejunostomy after operation, 3S-type jejunum and improved P-loops jejunum had a lower incidence in dumping syndrome and reflux esophagitis （P 〈 0.05 ）. No difference in 3S-type jejunum and improved P-loops jejunum 3S-type jejunum and improved P-loops jejunum was superior to P-loops Roux-en-Y esophagojejunostomy in serum total protein, albumin, hemoglobin, and nutritional assessment index（P 〈 0.05）. Conclusion Reconstruction of stomach with improved P-loops jejunum may prevent reflux esophagitis and dumping syndrome, and improve the nutritional status and the quality of life as 3S-type jejunum.