早期近端胃癌术后不同消化道重建方式对营养状况及胆囊结石的影响

Impact of different kinds of digestive tract reconstruction on nutritional status and cholecystolithiasis of patients with early gastric cancer underwent proximal gastrectomy

目的探讨早期近端胃癌术后不同消化道重建方式对术后营养状况及胆囊结石的影响。方法回顾性分析2013年1月至2016年6月82例行近端胃切除患者资料,其中40例行传统食管残胃吻合术(EG组),19例行单通道空肠间置术(JI组),23例行双通道空肠间置术(DTR组),采用SPSS24.0软件对数据进行分析,围术期指标以均数±标准差表示,三组间比较采用单因素方差分析,两两比较采用t检验;术后并发症及胆囊结石发生率比较采用χ2检验。P<0.05差异有统计学意义。结果DTR组及JI组较EG组手术时间更长(P<0.05);术后发生并发症反流性食管炎DTR组与JI组发生率低于EG组(P<0.05);三组患者术后1、3、6个月营养状况比较(总蛋白、白蛋白和血红蛋白),DTR组和JI组均优于EG组(P<0.05);三组患者术后2年累计发生胆囊结石比较,DTR组与JI组发生率低于EG组(P<0.05)。结论早期近端胃癌采用空肠间置吻合术可明显降低术后反流性食管炎发生,并且能够改善患者术后营养状况,降低胆囊结石的发生率,可提升患者生存质量,值得临床推广。

Objective To investigate the impact of different kinds of digestive tract reconstruction on nutritional status and cholecystolithiasis of patients with early gastric cancer underwent proximal gastrectomy.Methods From January 2013 to June 2016,clinical data of 82 patients underwent proximal gastrectomy were retrospectively analyzed,including 40 cases of traditional esophageal residual gastrostomosis(EG group),19 cases of single-channel jejunal interposition(SJI group),23 cases of dual-channel jejunal interposition(DJI group).Statistical analysis were performed by using SPSS24.0 software.Measurement data,such as perioperative indicators were expressed as(x±s),and were examined by one-way variance analysis and t test.Count data such as postoperative complications and the incidence of gallbladder stones were examined by chi square test.A P value<0.05 was considered as statistically significant difference.Results Compared with EG group,there were longer operation time in SJI group and DJI group(P<0.05).The incidence of reflux esophagitis in DJI group and SJI group were significantl lower than that in EG group(P<0.05).In terms of nutritional status(total protein,albumin and hemoglobin)at 1,3 and 6 months after operation in DJI group and SJI group were better than those in EG group respectively.Cumulative incidence of gallstones 2 years after operation in DJI group and SJI group were significantly lower than that in EG.Conclusion For patients with early gastric cancer undergo proximal gastrectomy and jejunal interposition could significantly reduce the incidences of reflux esophagitis,could effectively improve the nutritional status and could reduce the incidences gallstones,which could improve the quality of life and is worth of clinical promotion.