近端胃癌切除术后消化道重建方式的临床分析

Clinical analysis of modes of digestive tract reconstruction after resection of proximal gastric cancer

目的分析近端胃癌切除术后消化道重建方式的临床效果。方法选择我院近端胃癌患者50例,根据胃癌切除术后消化道重建方式的不同,将患者分为两组:对照组与实验组,各25例;其中对照组患者行根治性全胃切除术后采用食管空肠直接吻合术治疗,实验组患者行根治性近端胃癌根治术后采用食管远端胃空肠间置术的消化道重建治疗,对两组患者进行6个月的随访,对两组胃癌患者的手术指标和并发症情况、营养学指标以及食管反流现象进行比较。结果实验组患者手术时间略长于对照组患者,差异有统计学意义(P<0.05);对照组患者住院时间、术后肛门排气时间与实验组患者住院时间、术后肛门排气时间基本相同,差异无统计学意义(P>0.05)。两组患者术后并发症发生率基本相同,差异无统计学意义(P>0.05)。实验组患者饮食量和体重增加指标优于对照组患者,实验组患者生活质量明显优于对照组患者,两组比较差异有统计学意义(P<0.05)。结论近端胃癌根治术后消化道重建方式中,食管远端胃空肠间置术具有显著效果,能够对患者的临床症状、营养情况和生活质量等进行改善,且并发症发生率相似,值得临床推广与应用。

Objective To analyze the clinical effect of the mode of digestive reconstruction in the resection of proximal gastric cancer. Methods A total of 50 patients with proximal gastric cancer were selected. According to the different ways of digestive tract reconstruction after gastric cancer resection, the patients were divided into two groups： the con- trol group and the experimental group, with 25 patients in each group. The control group was given esophageal jejunum direct anastomosis after radical total gastrectomy, and the experimental group was given digestive reconstruction in gas- trojcjunostomy of distant esophagus after radical proximal gastrectomy. Two groups of patients were followed up for 6 months. The operation indices and complication, nutritional indices and esophageal reflux were comprehensively deter- mined in the two groups of patients with gastric cancer. Results The operation time in the experiment group was longer than that in the control group, the difference was statistically significant（P〈0.05）. The postoperative length of stay, post- operative anal exhaust time and incidence rate of complications in the experiment group were similar to those in the control group, the difference was no statistically significant（P〉0.05）; the dietary quality and weight gain in the experimental group were better than those in the control group. The quality of life in the experiment group was significantly better than that in the control group, the difference was statistically significant（P〈0.05）. Conclusion Gastrojejunostomy of distal esophagus has a significant effect in the reconstruction of digestive tract after radical resection of proximal gastric can- cer. It can improve the clinical symptoms, nutritional status and quality of life of the patients, and the incidence rate of complications is similar, which is .worthy of clinical promotion and application.