两种间置空肠吻合术应用于食管胃结合部腺癌近端胃切除术后消化道重建临床研究

Effect of two kinds of interposed jejunostomy in gastrointestinal reconstruction after proximal gastrectomy for adenocarcinoma of esophagogastric junction

目的:探究不同间置空肠吻合术在食管胃结合部腺癌(AEG)近端胃切除术(PG)后消化道重建中的应用效果。方法:随机硬币投掷法将83例AEG患者分为单通道吻合术(STR)组和双通道吻合术(DTR)组。患者均接受PG治疗,STR组术后选择STR进行消化道重建,DTR组则给予DTR技术。对比两组一般手术情况、术后6个月营养状态、术后7 d氧化炎症反应状态、反流性食管炎发生情况。分析反流性食管炎发生与术后7 d氧化炎症反应状态的相关性。结果:两组术中出血量、手术时间、术后肠鸣音恢复、首次排气、进食、住院时间及术后7 d血清白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、超氧化物歧化酶(SOD)和丙二醛(MDA)间比较,差异无统计学意义(均P>0.05)。DTR组术后6个月血红蛋白、血清白蛋白、总蛋白水平低于STR组,但维生素B水平高于STR组(均P<0.05),两组术后反流性食管炎发生率间差异无统计学意义(P>0.05),但与无反流性食管炎者相比,并发反流性食管炎者术后7 d时血清IL-6、TNF-α和MDA水平明显升高,SOD水平明显下降(均P<0.05)。结论:两种间质空肠吻合术均可在AEG患者对机体氧化炎症反应影响作用和反流性食管炎预防作用相当,但STR组更有助于术后蛋白类营养物质积累,DTR有助于维生素吸收。术后早期氧化炎症反应水平与反流性食管炎发生存在一定相关性。

Objective:To investigate the application effect of two kinds of interposed jejunostomy in gastrointestinal reconstruction after proximal gastrectomy(PG) for adenocarcinoma of the esophagogastric junction(AEG).Methods:A total of 83 patients with AEG were divided into STR group and DTR group by random coin tossing method.All patients received PG therapy.The STR group was given STR for digestive tract reconstruction after surgery,and the DTR group was given DTR technology.The general surgical conditions,nutritional status at 6 months after operation,oxidative inflammatory response status at 7 days after operation,and the occurrence of reflux esophagitis were compared between the two groups.The correlation between the occurrence of reflux esophagitis and the state of oxidative inflammation at 7 days after operation was analyzed.Results:There was no significant difference in intraoperative blood loss,operation time,postoperative bowel sound recovery time,first exhaust time,first eating time,and hospitalization time,as well as serum interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),superoxide dismutase(SOD) and malondialdehyde(MDA) at 7 days after operation between the two groups(all P>0.05).The levels of hemoglobin,serum albumin and total protein in the DTR group at 6 months after operation were lower than those in the STR group,but the level of vitamin Bwas higher than that in the STR group(all P<0.05).There was no significant difference in the incidence of postoperative reflux esophagitis between the two groups(P<0.05).Compared with those without reflux esophagitis,the serum IL-6,TNF-α and MDA levels were significantly increased,and the SOD level at 7 days after operation in the patients with reflux esophagitis was significantly decreased(all P<0.05).Conclusion:Both types of interstitial jejunostomy can affect the body’s oxidative inflammatory response and the preventive effect of reflux esophagitis in patients with AEG,but the STR group is more conducive to the accumulation of postoperative protein nutrients,and DTR is conducive to the absorption of vitamins.There is a certain correlation between the level of early postoperative oxidative inflammation and the occurrence of reflux esophagitis.