胃癌全胃切除术中行调节型双通道消化道重建对患者胆囊收缩功能及营养状况的影响

The effect of regulative dual-channel digestive tract reconstruction on the gallbladder systolic function and nutritional status in patients undergoing gastric cancer surgery

目的评价调节型双通道消化道重建在胃癌全胃切除术中的应用价值。方法接受全胃切除术治疗的胃癌病人82例,以随机数字表法将82例病人分为对照组41例,胃切除后行Roux-en-Y吻合术;观察组41例,胃切除后行调节型双通道消化道重建。观察两组病人手术及术后恢复情况,术前、术后3个月胆囊收缩功能及营养状况变化,术后并发症发生率。结果观察组消化道重建时间与对照组对比,差异有统计学意义(P <0. 05),两组病人术中出血量、术后肛门排气时间、术后排便时间及术后住院时间比较,差异无统计学意义(P> 0. 05);术前两组胆囊收缩功能及营养状况比较差异无统计学意义(P> 0. 05),观察组术后3个月空腹胆囊体积、脂肪餐后胆囊体积、胆囊收缩率及血清总蛋白(TP)、血红蛋白(HGB)及白蛋白(ALB)水平与同期对照组对比,差异有统计学意义(P <0. 05);观察组术后肺部感染、吻合口狭窄、吻合口出血发生率与对照组对比,差异无统计学意义(P> 0. 05);观察组术后倾倒综合征、反流性食管炎、胆囊结石发生率与对照组对比,差异有统计学意义(P <0. 05)。结论应用调节型双通道消化道重建在胃癌根治术中,可改善病人营养状况,对胆囊收缩功能影响小,能明显减少术后并发症。

Objective To investigate the application value of regulative dual-channel digestive tract reconstruction in gastric cancer surgery. Methods A total of 82 patients with gastric cancer who underwent radical surgery were selected as the study subjects,the random digital table was divided into 41 cases in the control group and 41 in the observation group,Roux-en-Y anastomosis was performed after gastrectomy in the control group,and regulative dual-channel digestive tract reconstruction was performed after gastrectomy in the observation group. The operation and postoperative recovery,the changes of gallbladder systolic function and nutritional status before and 3 months after operation,the incidence of postoperative complications of two groups were observed. Results Compared with the control group,the time of digestive tract reconstruction in the observation group was statistically significant（ P〈0. 05）,the differences in intraoperative blood loss,postoperative anus exhaust time,postoperative defecation time and postoperative hospital stay of two groups were not statistical significance（ P〉0. 05）. There was no significant difference in gallbladder contractile function and nutritional status between the two groups before operation（ P〉0. 05）,The fasting gallbladder volume,post-meal gallbladder volume,gallbladder contraction rate and thethe serum total protein（ TP）,hemoglobin（ HGB） and albumin（ ALB） levels in the observation group at 3 months after operation were compared with those of the control group at the same time,the difference was statistically significant（ P〉0. 05）. The incidences of postoperative pulmonary infection,anastomotic stenosis,and anastomotic bleeding in the observation group compared with the control group,the difference was not statistically significant（ P〈0. 05）,the incidences of postoperative dumping syndrome,reflux esophagitis,and gallstones in the observation group compared with the control group,the difference was statistically significant（ P〈0. 05）. Conclusion The application of regulative dual-channel digestive tract reconstruction in radical gastrectomy of gastric cancer can effectively improve the nutritional status of patients,has little effect on the contraction of gallbladder,and can significantly reduce postoperative complications,worth popularizing.