全胃切除术中2种吻合方式的临床对比研究

Clinical comparison of two types of anastomosis in total gastrectomy for patients with gastric cancer

目的探讨并比较空肠间置三口与食管-空肠单口吻合用于行全胃切除术胃癌患者临床疗效及安全性。方法选取海南省农垦三亚医院近期收治的行全胃切除术胃癌患者140例,以随机抽样方法分为A组(70例)和B组(70例),分别行食管-空肠单口吻合和空肠间置三口吻合治疗;比较两组患者术后排气排便时间、住院时间、术后Christensen疲劳评分、炎症因子指标水平及并发症发生情况等。结果 B组患者术后排气排便时间和住院时间均长于A组,差异有统计学意义(P<0.05);B组患者术后Christensen疲劳评分高于A组,差异有统计学意义(P<0.05);B组患者术后C反应蛋白(CRP)和白细胞介素6(IL-6)水平均高于A组,差异有统计学意义(P<0.05);同时B组患者术后并发症发生率高于A组,差异有统计学意义(P>0.05)。结论相较于空肠间置三口吻合,食管-空肠单口吻合用于行全胃切除术胃癌患者治疗可促进术后胃肠功能恢复,降低疲劳程度及炎症反应,并有助于预防术后并发症发生。

Objective To investigate and compare clinical effects and safety of jejunal interposition with three holes and esophageal jejunum anastomosis with one hole in total gastrectomy for treatment of patients with gastric cancer. Methods Totally 140 patients with gastric cancer receiving total gastrectomy were chosen and randomly divided into group A （70 patients） with esophageal jejunum anastomosis with one hole and group B （70 patients） with jejunal interposition with three holes. The exhaust and defecation time after surgery, hospitalization time, Christensen fatigue score, inflammation factor levels after surgery and incidence of postoperative complications were compared between both groups. Results The exhaust and defecation time after surgery and the hospitalization time of the group B were significantly longer than those of the the group A （P 〈 0.05）. The Christensen fatigue score after surgery in the group B was significantly higher than that of the group A （P 〈 0.05）. The serum CRP and IL-6 levels after surgery in the group B were significantly higher than those in the group A （P 〈 0.05）. The incidences of postoperative complications of the group B were significantly higher than those of the group A （P 〈 0.05）. Conclusions Compared with jejunal interposition with three holes, esophageal jejunum anastomosis with one hole in total gastrectomy for the patients with gastric cancer can efficiently speed up recovery process of postoperative gastrointestinal function, reduce fatigue degree and inflammation, and is helpful to prevent postoperative complications.