不同手术方式对早期胃上部癌患者术后营养状况及体质量的影响

Effects of Different Surgical Methods on Postoperative Nutritional Status and Body Weight of Patients with Early Upper Gastric Cancer

目的:探讨不同手术方式对早期胃上部癌患者术后营养状况及体质量的影响。方法:选择本院于2017年5月-2019年6月接诊且拟行手术治疗的82例早期胃上部癌患者。将患者按随机数字表法分为A组和B组,每组41例。B组行常规全胃切除,术中行食管-空肠Roux-en-Y吻合,A组行近端胃根治性切除,保留远端胃,术中行食管-空肠吻合、空肠-残胃侧侧吻合和空肠-空肠吻合的双通道重建手术。比较两组营养状况、体质量、生存质量及并发症发生情况。结果:术后,A组总蛋白、血红蛋白、白蛋白水平均高于B组,差异均有统计学意义(P<0.05)。术后,A组的健康、支持、日常生活、活动及精神评分均高于B组,差异均有统计学意义(P<0.05)。术后,A组的体质量大于B组,差异有统计学意义(P<0.05)。A组术后并发症发生率为4.88%,与B组的9.76%比较,差异无统计学意义(P>0.05)。结论:与常规全胃切除联合食管-空肠Roux-en-Y吻合相比,早期胃上部癌术中行近端胃根治性切除,保留远端胃的双通道重建手术可改善患者术后营养状况,提高体质量与生存质量,且安全可行,值得临床推广。

Objective:To investigate the effects of different surgical methods on postoperative nutritional status and body weight of patients with early upper gastric cancer.Method:A total of 82 patients with early upper gastric cancer who were admitted to our hospital from May 2017 to June 2019 and planned to undergo surgical treatment were selected.They were divided into group A and group B according to the random number table method,41 cases in each group.In group B,routine total gastrectomy was performed,and Roux-en-Y esophagojejunostomy was performed during the operation.In group A,radical resection of proximal stomach was performed,distal stomach was preserved,and double channel reconstruction of esophagojejunostomy,jejunum remnant stomach side to side anastomosis and jejunum jejunum anastomosis were performed during operation.Nutritional status,body weight,quality of life and complications were compared between the two groups.Result:After the operation,the levels of total protein,hemoglobin and albumin in group A were all higher than those in group B,with statistically significant differences(P<0.05).After the operation,the health,support,daily life,activities and spirit scores of group A were all higher than those of group B,with statistically significant differences(P<0.05).After surgery,the body weight of group A was greater than that of group B,with statistically significant difference(P<0.05).The incidence of postoperative complications in group A was 4.88%,which was not statistically significant compared with 9.76%in group B(P>0.05).Conclusion:Compared with conventional total gastrectomy combined with esophagojejunostomy Roux-en-Y anastomosis,radical proximal gastrectomy and distal gastric double channel reconstruction can improve postoperative nutritional status,body mass and quality of life of patients with early upper gastric cancer,which is safe and feasible,and worthy of clinical promotion.