P型空肠袢食管空肠Roux-en-Y吻合术和改良空肠间置代胃术在胃癌全胃切除术后的疗效评价

Evaluation of P shape jejunum pan jejunum esophagus Royx-en-Y anastomosis and modified jejunal interposition in total gastrectomy for gastric cancer

目的评价P型空肠袢食管空肠Roux-en-Y吻合术和改良空肠间置代胃术这两种消化道重建方式的疗效。方法选取2012年3月至2013年12月收治的64例胃癌患者,随机分为试验组和对照组,每组32例。对照组患者采用P型空肠袢食管空肠Roux-en-Y吻合术,试验组患者采用改良空肠间置代胃术。评价指标为消化道重建时间、术后进食频率、术后6个月患者营养指标改变(血红蛋白、白蛋白、总蛋白及体重下降幅度)及并发症发生率,并对两组患者术后疗效进行比较。结果患者年龄、病程、病变部位等临床一般特征差异无统计学意义(P>0.05)。试验组和对照组患者的消化道重建时间分别为(38.12±12.32)d和(47.92±11.36)d,术后进食频率分别为8次/d和2次/d,体重下降幅度分别为(10.36±3.31)d和(13.62±5.23)d,差异均有统计学意义(均P<0.05)。试验组患者术前和术后的营养指标血红蛋白分别为(26.4±8.4)g/L和(44.3±13.3)g/L,白蛋白分别为(78.6±26.6)g/L和(122.7±39.7)g/L,总蛋白分别为(47.2±15.2)g/L和(69.5±21.5)g/L,差异均有统计学意义(均P<0.05)。对照组患者术前和术后血红蛋白分别为(79.4±25.4)g/L和(90.1±29.1)g/L,白蛋白分别为(25.8±8.8)g/L和(29.6±9.6)g/L,总蛋白含量分别为(46.9±21.9)g/L和(51.2±16.2)g/L,差异均无统计学意义(均P>0.05)。对照组患者的营养指标均低于试验组,差异有统计学意义(P<0.05)。两组患者术后并发症发生率分别为15.6%和65.6%,差异有统计学意义(P<0.05);其中试验组呕吐2例,腹泻1例,倾倒综合征1例,反流性食管炎1例,对照组呕吐6例,腹泻5例,倾倒综合征4例,反流性食管炎6例。结论与P型空肠袢食管空肠Roux-en-Y吻合术相比,改良空肠间置代胃术疗效更好,对于患者术后生活质量的提高有一定的帮助,值得临床推广应用。

Objective To compare the effect of digestive tract reconstruction by P shape jejunum pan jejunum esophagus Royx en Y anastomosis and modified jejunal interposition after total gastrectomy for gastric cancer. Methods 64 gastric cancer patients addimitted from March 2012 to December 2013 was di- vided into two group with random allocation, the research group with P shape jejunum pan jejunum esopha- gus Royx en Y anastomosis and the control group with modified jejunal interposition. Then digestive tract re- construction time, feeding frequency, nutrition index（ hemoglobin, albumin, total protein and weight drop） and he incidence of postoperative complications within six months were compared. Results Difference of age, gender, and tumor location in both groups was not statistically significant （ P 〉 0. 05 ）. The researchgroup and control group with the digestive tract reconstruction time, postoperative feeding frequency and weight, were （38.12 ± 12. 32 vs 47.92 ± 11.36）d, （8 vs 2）per/d, （10. 36 ±3.31 vs 13.62 ±5.23）d, respeetively. And the difference were statistically signifieant（ P 〈0. 05 ）. The postoperative nutrition indica- tors of the hemoglobin, albumin and total protein content in research group were （78. 6 ±26. 6 vs 122. 7± 39.7 ） , （26.4 ± 8.4 vs 44.3 ± 13.3 ） , （47.2 ± 15.2 vs 69.5 ± 21.5 ） , respectively, which was higher than preoperative （P 〈 0. 05 ） ; And in eontrol group were （ 79. 4 ± 25.4 vs 90. 1 ± 29. 1 ）, （ 25.8 ± 8.8 vs 29. 6 ±9. 6） ,（46. 9 ±21.9 vs 51.2 ± 16. 2） ,without significant difference （P 〉0. 05）. And the differ- ence between groups ws statistically signifieant （ P 〈 0. 05 ）. Finally, the postoperative eomplieation rate be- tween research group（ 15.61% ） and control group（65.62% ） was statistieally significant （P 〈0.05）. Re- seareh group with 2 eases of vomiting, 1 ease of diarrhea, 1 ease of dumping syndrome, 1 ease of reflux esophagitis, and control group with 6 eases, 5 eases, 4 eases, 6 eases, respectively. And differences also existed significantly between them. Conclusion The effect of modified jejunal interposition is superior to P shape jejunum pan jejunum esophagus Royx en Y anastomosis, which is benefieial to the life quality of post- operative gastric eaneer patients and worthy to be used widely.