两种不同的食管空肠重建方法对胃癌根治术患者消化道重建的影响研究

Effects of Two Different Methods of Esophageal Jejunal Reconstruction on Digestive Tract Reconstruction in Patients with Radical Gastrectomy for Gastric Cancer

目的:探讨腹腔镜全胃切除术后食管空肠不同重建方法对患者营养状态与胃肠功能指标的影响,为临床治疗提供参考。方法:选取2016年7月-2021年3月苏州大学附属常熟医院收治的76例胃癌根治术患者为研究对象,根据随机数字表法将其分为对照组和观察组,每组38例。两组均行腹腔镜全胃切除术,对照组同时行空肠食管Roux-en-Y吻合术,观察组同时行"P"形空肠袢空肠食管Roux-en-Y吻合术。比较两组围手术期各项指标、术后并发症发生情况及术后6个月Visick分级;比较两组术前、术后6个月营养指标及胃泌素、胆囊收缩素、生长抑素以及胃动素水平。结果:两组术中出血量比较,差异无统计学意义(P>0.05);但对照组手术时间、胃肠功能恢复时间及住院时间均长于观察组(P<0.05)。术前,两组营养指标比较,差异均无统计学意义(P>0.05);术后6个月,两组营养指标均高于术前,且观察组均高于对照组(P<0.05)。观察组术后6个月Visick分级情况明显优于对照组患者(P<0.05)。术前,两组血清胃肠激素水平比较,差异均无统计学意义(P>0.05);术后6个月,两组胃泌素、生长抑素和胃动素均低于术前(P<0.05),但观察组胃泌素和生长抑素均高于对照组(P<0.05),两组胃动素比较差异无统计学意义(P>0.05);术后6个月,两组胆囊收缩素均高于术前,但观察组低于对照组(P<0.05)。两组术后并发症发生率比较,差异无统计学意义(P>0.05)。结论:与空肠食管Roux-en-Y吻合术相比,"P"形空肠袢空肠食管Roux-en-Y吻合术在一定程度上更有利于胃肠功能的恢复,对营养状况的进一步改善和生活质量的提高有明显的促进作用,有利于患者术后康复。

Objective:To investigate the effects of different reconstruction methods of esophagus and jejunum on nutritional status and gastrointestinal function indexes of patients after laparoscopic total gastrectomy,and to provide reference for clinical treatment.Method:A total of 76 patients undergoing radical gastrectomy for gastric cancer in Changshu Hospital Affiliated to Soochow University from July 2016 to March 2021 were selected as the research objects,and they were divided into the control group and the observation group according to random number table method,38 cases in each group.Laparoscopic total gastrectomy was performed in both groups,while Roux-en-Y jejunoesophageal anastomosis was performed in the control group and“P”shaped loop jejunoesophageal Roux-en-Y jejunoesophageal anastomosis was performed in the observation group.Perioperative indicators,postoperative complications and Visick grading 6 months after operation were compared between two groups;nutritional indexes and the levels of gastrin,cholecystokinin,somatostatin and motilin of two groups before and 6 months after operation were compared.Result:There was no significant difference in intraoperative blood loss between two groups(P>0.05);but the operation time,gastrointestinal function recovery time and hospitalization time in the control group were longer than those in the observation group(P<0.05).Before operation,there were no significant differences in the nutritional indexes of two groups(P>0.05);at 6 months after operation,the nutritional indexes of two groups were higher than those before operation,and the observation group were higher than those of the control group(P<0.05).The Visick grade of the observation group at 6 months after operation was significantly better than that of the control group(P<0.05).Before operation,there were no significant differences in the levels of serum gastrointestinal hormones between two groups(P>0.05);at 6 months after operation,the levels of gastrin,somatostatin and motilin in two groups were lower than those before operation(P<0.05),but the levels of gastrin and somatostatin in the observation group were higher than those in the control group(P<0.05),there was no significant difference in the level of motilin between two groups(P>0.05);at 6 months after operation,the levels of cholecystokinin in two groups were higher than those before operation,but the observation group was lower than that in the control group(P<0.05).There was no statistical difference in the incidence of postoperative complications between two groups(P>0.05).Conclusion:Compared with Roux-en-Y jejunoesophageal anastomosis,“P”shaped jejunal loop Roux-en-Y jejunoesophageal anastomosis is more conducive to the recovery of gastrointestinal function to a certain extent,plays an obvious role in promoting the further improvement of nutritional status and the improvement of quality of life,and is conducive to the postoperative rehabilitation of patients.