腹腔镜全胃切除术后不同消化道重建方式对胃癌患者胆囊收缩功能及术后并发症的影响

The effects of different digestive tract reconstruction methods on gallbladder contraction function and postoperative complications in patients with gastric cancer after laparoscopic total gastrectomy

目的观察腹腔镜全胃切除术后采取不同消化道重建方式对胃癌患者胆囊收缩功能、术后并发症情况的影响。方法选取我院行腹腔镜全胃切除术治疗的胃癌患者98例,利用随机数字表法分为两组各49例,A组采取功能性空肠间置代胃重建术(FJI),B组采取Roux-en-Y重建术,比较两组手术指标、手术前后营养代谢情况体质量指数(BMI)、血红蛋白(Hb)、总蛋白(TP)、预后营养指数(PIN)、胆囊收缩功能胆囊容积、胆囊排空率、胆囊收缩素(CCK)水平、胃肠功能(代胃肠管最大径值与管内钡剂停留时长)及术后并发症情况等。结果两组患者手术重建时间与术中出血量比较差异无统计学意义(P>0.05);A组术后6个月BMI、Hb、TP、PIN均显著高于B组;术后胆囊容积、CCK水平低于B组,胆囊排空率高于B组;术后6个月代胃肠管最大径值大于B组,管内钡剂停留时间长于B组;术后R-S综合征与倾倒综合征发生率明显低于B组,差异均有统计学意义(P<0.05)。结论胃癌患者腹腔镜全胃切除术后采取FJI更益于胆囊收缩功能恢复,可更好促进机体营养代谢,提高消化吸收功能,降低术后并发症风险。

Objective To observe the effects of different digestive tract reconstruction methods on gallbladder contraction function and postoperative complications in patients with gastric cancer after laparoscopic total gastrectomy.Methods A total of 98 patients with gastric cancer who underwent laparoscopic total gastrectomy were selected.They were randomly divided into group A and B,49 in each group.The group A was treated with functional jejunal interposition(FJI)while the group B was treated with Roux-en-Y reconstruction.The surgical indexes,nutrition metabolism status estimated by body mass index(BMI),hemoglobin(Hb),total protein(TP)and prognostic nutritional index(PIN),gallbladder contraction function estimated by gallbladder volume,gallbladder emptying rate and cholecystokinin(CCK)level and gastrointestinal function assessed by the maximum diameter of gastrointestinal tube and stay time of barium in tube before and after surgery as well as postoperative complications were compared between the two groups.Results There were no significant differences between the two groups in reconstruction time and intraoperative blood loss(P>0.05).After 6 months of surgery,BMI,Hb TP and PIN were significantly higher,gallbladder volume and CCK level were significantly lower,the gallbladder emptying rate,the maximum diameter of the gastrointestinal tube,and barium stay time were significantly higher and longer in the group A than those in the group B.The incidences of postoperative R-S syndrome and dumping syndrome were significantly lower in the group A than those in the group B(P<0.05).Conclusion The application of FJI after LTG to patients with gastric cancer is more beneficial to the recovery of gallbladder contraction function.The function recovery can better promote the nutritional metabolism,improve the digestion and absorption and reduce the risk of postoperative complications.