胃癌全胃切除术后三种消化道重建方法对比研究

Comparetive study on three types of digestive reconstruction after total gastrectomy for gastric cancer

目的:探讨胃癌全胃切除术后理想的消化道重建方式。方法:对98例胃癌患者按全胃切除术后消化道重建方式的不同,分为Lahey+Braun式食管空肠端侧吻合术(Ⅰ组,n=34)、P型空肠袢食管空肠Rouxen-Y吻合术(Ⅱ组,n=28)及改良功能性空肠间置代胃术(Ⅲ组,n=36)。比较3种术式患者术后并发症发生率及营养指标。结果:Ⅱ组和Ⅲ组术后患者的营养状况均明显优于Ⅰ组,P<0.05;Ⅱ组和Ⅲ组术后并发症也明显少于Ⅰ组,P<0.05。Ⅱ组与Ⅲ组患者的营养指标变化和术后并发症相比,除体重外均无明显差异,P>0.05。结论:全胃切除后P型空肠袢Roux-en-Y吻合术和改良功能性空肠间置代胃重建方式较Lahey+Braun式食管空肠端侧吻合术为胃癌行全胃切除消化道重建较理想的术式,更有利于患者的营养恢复及减少术后并发症发生率。

Objective:To investigate the effect of rational digestive reconstruction after total gastrectomy for gastric cancer.Methods:Three types of digestive reconstruction were performed after total gastrectomy in 98 cases with gas-tric carcinoma.The incidence of postoperative complications and nutritional status were compared.Results:Compared to group Ⅰ,groupⅡ and Ⅲ had a better nutritional status(P<0.05 ).The incidence of postoperative complications in group Ⅱ and Ⅲ were less than group Ⅰ(P<0.05).The incidence of postoperative complications and nutritiona status in groupⅡandⅢhad no significant difference except body weight.Conclusion:GroupⅡandⅢcan be rec-ommended as an adoptable method of digestive reconstruction after total gastrectomy for gastric carcinoma because of maintaining better nutritional status and less postoperative complications.