空肠间置代胃术在胃癌患者全胃切除中的临床效果

Clinical Efficacy of Jejunum Interposition in Radical Gastrectomy for Gastric Carcinoma Patients

目的观察根治性全胃切除后进行空肠间置代胃术与单纯Roux-en-Y吻合术对胃癌患者疗效的影响。方法临床纳入进行根治性全胃切除的胃癌患者90例,根据全胃切除术后消化道重建方式的不同分为研究组与对照组,研究组进行空肠间置代胃术,对照组进行单纯Roux-en-Y吻合术。观察2组手术后血红蛋白浓度(Hb)、血浆前白蛋白(PA)、血浆总蛋白(TP)差异;采用Spitzer评分方法对术后患者生活质量进行评价;观察术后2组患者并发症发生率。结果术后6个月,2组患者Hb、PA、TP水平差异无统计学意义(P>0.05);术后12个月,研究组Hb、PA、TP水平分别为(122.26±14.06)g/L、(325.48±11.62)mg/L、(64.05±3.54)g/L,对照组Hb、PA、TP水平分别为(133.65±18.26)g/L、(345.64±18.37)mg/L、(67.26±4.55)g/L,2组差异均有统计学意义(P<0.05)。术后12个月对患者进行Spitzer评分:研究组活动情况、健康状况、总分分别为(1.42±0.62)、(1.13±0.64)、(1.36±0.62),对照组分别为(0.85±0.65)、(0.71±0.66)、(1.14±0.59),2组差异均有统计学意义(P<0.05)。研究组术后并发症发生率为4.44%,远低于对照组的22.22%,差异有统计学意义(P<0.05)。结论胃癌患者采用根治性全胃切除空肠间置代胃术,能够有效提高术后肠道吸收功能,改善营养状况,并能在一定程度上提高患者的生活质量,值得推广。

Objective To observe the curative effects of jejunum interposition and Roux-en-Y anastomosis in radical gastrectomy for gastric carcinoma patients. Methods 90 gastric carcinoma patients treated with radical gastreetomy were divided into the research group and the control group according to different reconstructions of digestive tract. The research group adopted jejunum interposition and the control group adopted Roux-en-Y anastomosis. After treatment, the concentration of Hb, PA and TP of the 2 groups were observed ;the postoperative life quality based on Spitzer score was evaluated. Results 6 months after treatment, the levels of Hb, PA and TP of the 2 groups were not significantly different （ P 〉 0.05 ） ; 12 months after treatment, the levels of Hb, PA and TP of the research group were （ 122.26 ±14.06） g/L, （ 325.48 ±11.62 ） mg/L, （64.05 ±3.54） g/L while the levels of the control group were （ 133.65 ±18.26） g/L, （ 345.64 ±18.37 ） mg/L, （ 67.26 ±4.55 ） g/L （ P 〈 0.05 ） ; based on Spitzer score, the scores of activity, health condition and total score of the research group 12 months after treatment were （ 1.42 ±0.62） ,（1.13 ±0.64） and （ 1.36 ±0.62） ,while the scores of the control group were （0.85 ±0.65）, （0.71 ±0.66） and （ 1.14 ±0.59 ） （ P 〈 0.05 ）. Conclusion For gastric carcinoma patients, jejunum interposition in radical gastrectomy can efficiently improve the postoperative intestinal absorption function, nutrition status and quality of life of patients to a certain extent. It is worthy of promotion.