胃癌手术应用空肠侧侧吻合术联合空肠营养管的疗效分析

Efficacy analysis of jejunal side anastomosis combined with jejunal nutrition tube in gastric cancer surgery

目的研究对比胃癌手术中加做直线切割闭合器行空肠侧侧吻合术并放置空肠营养管与单纯应用Bill-rothⅡ毕罗氏二式(BⅡ)胃肠吻合术患者的不良反应及术后炎症反应发生情况。方法回顾性病例对照研究华北理工大学附属医院2017年2月至2020年4月胃癌手术患者93例的临床资料,按2016美国癌症联合会(American Joint Committee on Cancer,AJCC)/国际抗癌联盟(Universal Integrated Circuit Card,UICC)分期按照肿瘤、淋巴结转移、远处转移(tumor,node,metastasis,TNM)标准进行分期,其中ⅠA期11例、ⅠB期14例、ⅡA期13例、ⅡB期15例,ⅢA期11例、ⅢB期13例、ⅢC期16例。其中胃窦癌51例、胃体癌26例、胃幽门癌16例,其中乳头状腺癌27例、管状腺癌26例、黏液腺癌22例、印戒细胞癌9例、腺鳞癌7例、鳞癌2例。按是否加做直线切割闭合器行空肠侧侧吻合术并放置空肠营养管方法分为试验组(48例)和对照组(45例)。比较两组患者的性别构成、年龄、病变部位、病理类型、病理分期、术后住院时间、术后并发症,比较两组患者术后第7天白细胞计数(white blood cell count,WBC)、C-反应蛋白(C-reactive protein,CRP)、红细胞沉降率(erythrocyte sedimentation rate,ESR)、肿瘤坏死因子α(tumor necrosis factor-α,TNF-α)、白细胞介素6(interleukin-6,IL-6)炎症指标。计量资料两组间比较采用独立样本t检验,计数资料比较采用χ^(2)检验。结果两组患者的性别构成、年龄、病变部位、病理类型、病理分期比较差异均无统计学意义(均P>0.05),93例患者术后腹痛发生率为18.3%(17/93)、腹胀21.5%(20/93)、恶心23.7%(22/93)、呕吐17.2%(16/93)、胸腔积液18.3%(17/93),试验组和对照组上述指标的并发症发生率依次为10.4%(5/48)与26.7%(12/45)、12.5%(6/48)与31.1%(14/45)、15.6%(7/48)与33.3%(15/45)、8.3%(4/48)与26.7%(12/45)、8.3(4/48)与28.9%(13/45),两组比较差异均有统计学意义(χ^(2)值分别为4.11、4.77、4.52、4.27、5.27,P值分别为0.043、0.029、0.033、0.039、0.022);两组患者下肢静脉血栓、吻合口出血、坠积性肺炎、切口裂开比较差异均无统计学意义(均P>0.05),试验组与对照组患者术后第7天WBC分别为(7.02±1.83)×10^(9)/L与(8.39±2.27)×10^(9)/L(t=3.22,P=0.002),TNF-α分别为(2.44±0.70)μg/L与(3.56±1.14)μg/L(t=5.71,P<0.001),IL-6分别为(235.31±41.72)μg/L与(365.91±73.16)μg/L(t=10.66,P<0.001),两组比较差异均有统计学意义。两组患者术后第7天CRP、ESR比较差异均无统计学意义(P均>0.05)。试验组与对照组患者术后住院时间分别为(13.88±2.81)d与(22.78±2.51)d,两组比较差异有统计学意义(t=16.07,P<0.001)。结论胃癌手术应用空肠侧侧吻合术联合空肠营养管给予患者肠内营养,能减少患者术后腹痛、腹胀、坠积性肺炎、恶心、呕吐、胸腔积液等不良反应的发生,减少患者术后住院时间,一定程度上减少患者术后炎症反应。

Objective To investigate the adverse reactions and postoperative inflammatory reactions of Bill-RothⅡ(BⅡ)gastroenterostomy with jejunal anastomosis and jejunal nutrient tube placement using linear cutting and closing device in gastric cancer surgery.Methods A retrospective case-control study was conducted on 93 patients undergoing gastric cancer surgery in The Affiliated Hospital of North China University of Science and Technology from February 2017 to April 2020.According to 2016(American Joint Committee on Cancer/Universal Integrated Circuit Card)AJCC/UICC,(Tumor,Node,stage;Tumor lymph node metastasis;Distant metastasis)TNM,there were 11 cases in stageⅠA,14 cases in stageⅠB,13 cases in stageⅡA,15 cases in stageⅡB,11 cases in stageⅢA,13 cases in stageⅢB,and 16 cases in stageⅢC.There were 51 cases of gastric antrum carcinoma,26 cases of gastric body carcinoma and 16 cases of gastric pylorus carcinoma.There were 27 cases of papillary adenocarcinoma,26 cases of tubular adenocarcinoma,22 cases of mucinous adenocarcinoma,9 cases of signet-ring cell carcinoma,7 cases of adenosquamous carcinoma,and 2 cases of squamous carcinoma.The patients were divided into experimental group(48 cases)and control group(45 cases)according to whether or not the linear cutting and closing device was added and jejunal anastomosis was performed and jejunal nutrition tube was placed.The gender composition,age,lesion site,pathological type,pathological stage,postoperative hospital stay and postoperative complications were compared between the two groups,and the white blood cell count WBC,C-reactive protein CRP on the 7th day after surgery,erythrocyte Sedimentation rate(ESR),tumor necrosis factor-α(TNF-α),interleukin-6(IL-6)inflammation indicators were compared between the two groups.Results There was no significant difference in gender composition,age,lesion location,pathological type and pathological stage between the two groups(all P>0.05).The incidence of abdominal pain,abdominal distension,nausea,vomiting and pleural effusion in 93 patients were 18.3%(17/93),21.5%(20/93),23.7%(22/93),17.2%(16/93)and 18.3%(17/93),respectively.The complication rates of the above indexes in the two groups were 10.4%(5/48)Compared with 26.7%(12/45),12.5%(6/48)and 31.1%(14/45),15.6%(7/48)and 33.3%(15/45),8.3%(4/48)and 26.7%(12/45),8.3%(4/48)and 28.9%(13/45)(χ^(2) values were 4.11,4.77,4.52,4.27 and 5.27,respectively;P values were 0.043,0.029,0.033,0.039 and 0.022,respectively).There was no significant difference in lower extremity venous thrombosis,anastomotic bleeding,accumulated pneumonia and incision dehiscence between the two groups(P>0.05).WBC on the 7th day after operation in the experimental group and the control group(7.02±1.83)×10^(9)/L and(8.39±2.27)×10^(9)/L(t=3.22,P=0.002),TNF-α(2.44±0.70)μg/L and(3.56±1.14)μg/L(t=5.71,P<0.001),IL-6(235.31±41.72)μg/L and(365.91±73.16)μg/L(t=10.66,P<0.001)there was significant difference between the two groups.There was no significant difference in CRP and ESR between the two groups on the 7th day after operation(P>0.05).The postoperative hospital stay between the experimental group and the control group was(13.88±2.81)d and(22.78±2.51)d,the difference was statistically significant(t=16.07,P<0.001).Conclusion The application of side-to-side jejunostomy combined with jejunal nutrition tube for enteral nutrition in gastric cancer surgery can reduce the occurrence of adverse reactions such as postoperative abdominal pain,abdominal distension,accumulated pneumonia,nausea,vomiting and pleural effusion,reduce the postoperative hospital stay and reduce the postoperative inflammatory reaction to a certain extent.