间置空肠在腹腔镜胃癌根治术中的应用及对胃肠道功能的影响

Interposition of Jejunum in Laparoscopic Radical Gastric Cancer Surgery and the Effect on the Function of Gastrointestinal Tract

目的:分析间置空肠在腹腔镜胃癌根治术中的应用及对胃肠道功能的影响。方法:选取2018年10月—2019年10月禹州钧都医院收治的89例胃癌患者作为研究对象。按照消化道重建术式不同分为对照组(n=43)和观察组(n=45)。两组患者均接受腹腔镜胃癌根治术治疗,对照组术中进行传统食管—残胃吻合术,观察组进行间置空肠吻合术。比较两组患者一般指标、胃肠道功能恢复时间、术后反流情况和pH<4.0的总时间、生活质量和并发症。结果:观察组患者手术时间、术中出血量、消化道重建时间、住院时间均少于对照组,差异有统计学意义(t=15.133、17.534、29.853、9.871,P<0.05);观察组患者术后排气时间、进流食时间、术后肠道恢复通气时间少于对照组,差异有统计学意义(t=54.911、21.957、19.148,P<0.05)。观察组患者平均反流次数、反流时间>5 min次数、最长反流时间和pH<4.0的总时间均少于对照组(t=24.525、9.639、28.621、30.114,P<0.05)。两组患者生活质量Visick分级比较,差异有统计学意义(Z=2.871,P<0.05)。观察组患者并发症低于对照组,差异有统计学意义(χ^(2)=8.115,P<0.05)。结论:间置空肠与腹腔镜胃癌根治术配合能减少术后并发症,促使胃肠道功能尽快恢复,减少反流情况,提升生活质量。

Objective:To analyze the use of interpositioned jejunum in laparoscopic radical gastric cancer surgery and the effect on the function of the gastrointestinal tract.Methods:Eighty-nine patients with gastric cancer admitted to the sample hospitals from October 2018 to October 2019 were selected for the study and divided into control(n=43)and observation groups(n=45)according to the different GI reconstruction procedures.Patients in both groups were treated with laparoscopic radical gastric cancer,and the control group underwent conventional esophage-residual gastric anastomosis intraoperatively,while the observation group underwent interposition jejunostomy.The general indicators,time to recovery of gastrointestinal function,postoperative reflux and total time of pH<4.0,quality of life and complications were compared between the two groups.Results:The operating time,intraoperative bleeding,GI reconstruction time,and hospital stay of patients in the observation group were less than those in the control group,and the differences were statistically significant(t=15.133,17.534,29.853,9.871,P<0.05).The postoperative time to ventilate,time to feed on fluids,and time to resume postoperative intestinal ventilation were less in the observation group than in the control group,and the differences were statistically significant(t=54.911,21.957,19.148,P<0.05).The mean number of refluxes,the number of refluxes>5 min,the longest reflux time and the total time of pH<4.0 were less in the observation group than in the control group,and the differences were statistically significant(t=24.525,9.639,28.621,30.114,P<0.05).There was a statistically significant difference in the quality of life Visick grading between the two groups(Z=2.871,P<0.05).The incidence of complications in the observation group was lower than that in the control group,and the difference was statistically significant(χ^(2)=8.115,P<0.05).Conclusion:Interpositioning the jejunum in conjunction with laparoscopic radical gastric cancer treatment can reduce postoperative complications,promote the recovery of gastrointestinal tract function as soon as possible,reduce reflux conditions,and improve the quality of life.