腹腔镜全胃切除术后双通道空肠间置对胃癌患者消化道重建的作用

Effect of dual-channel jejunal interposition on gastrointestinal reconstruction in patients with gastric cancer after laparoscopic total gastrectomy

目的腹腔镜全胃切除术后双通道空肠间置对胃癌患者消化道重建的作用。方法选择南阳市第一人民医院2020年1月至2021年1月接收的74例胃癌术后消化道重建患者,按抽签法分为传统组和观察组(各37例),主要是分析Roux-en-Y吻合术方式及双通道空肠间置消化道重建的差异性;观察指标:手术前后患者的血清炎症因子水平、满意度、营养状况、并发症、围术期指标以及生活质量。结果通过血清炎症因子水平检验结果发现,两组患者在手术前数据比较差异无统计学意义,在进行消化道重建后,观察组血清炎症因子水平更优[观察组C反应蛋白为(3.74±0.57)mg/L,传统组C反应蛋白为(4.96±1.18)mg/L,t=5.662,P<0.05;观察组白细胞介素-6为(15.86±1.50)ng/L,传统组白细胞介素-6为(18.71±1.53)ng/L,t=8.090,P<0.05];观察组手术满意度(97.3%)高于传统组(81.08%)(χ^(2)=5.045,P<0.05);观察组手术后前清蛋白[(0.43±0.07)g/L]高于传统组[(0.31±0.07)g/L](t=7.373,P<0.05);观察组手术后转铁蛋白[(3.16±1.03)g/L]高于传统组[(1.97±0.53)g/L](t=6.248,P<0.05);观察组手术后白蛋白[(41.67±2.57)g/L]高于传统组[(35.67±2.18)g/L](t=10.829,P<0.05);观察组手术后血红蛋白[(110.74±2.03)g/L]高于传统组[(105.43±2.53)g/L](t=9.957,P<0.05);观察组并发症(2.70%)低于传统组(16.22%),(χ^(2)=3.944,P<0.05);观察组围术期指标[手术失血量为(256.34±12.26)mL,消化道重建时长为(44.61±5.18)min,首次排气时间为(2.95±0.65)d,首次进食时间为(4.32±0.53)d],低于传统组[手术失血量为(276.85±12.58)mL,消化道重建时长为(49.74±5.57)min,首次排气时间为(3.68±0.52)d,首次进食时间为(5.46±1.03)d](手术失血量:t=7.102,P<0.05;消化道重建时长:t=4.102,P<0.05;首次排气时间:t=5.334,P<0.05;首次进食时间t=5.986,P<0.05)。结论对胃癌术后消化道重建患者采用双通道空肠间置消化道重建可行性高,值得推广。

【Objective】To explore the effect of two-channel jejunal interposition on digestive tract reconstruction in gastric cancer(GC)patients after laparoscopic total gastrectomy.【Methods】The experiment time was during Jan.2020 and Jan.2021.Seventy-four patients with gastrointestinal reconstruction were selected.They were grouped into traditional group and observation group(37 cases each)by drawing lots.The differences of Roux-en-Y anastomosis and double channel reconstruction were analyzed.Serum inflammatory factor level,satisfaction,nutritional status,complications,perioperative index and quality of life of patients before and after surgery were compared.【Results】From the test of serum inflammatory factor levels,there was no difference in preoperative data between the two groups.After performing a digestive tract reconstruction,levels of serum inflammatory factors were significantly better in the observation group(C reactive protein:3.74±0.57 mg/L in the observation group,4.96±1.18 mg/L in the traditional group,t=5.662,P<0.05;interleukin-6:15.86±1.50 ng/L in the observation group,18.71±1.53 ng/L in the traditional group,t=8.090,P<0.05).The patient surgical satisfaction in the observation group(97.3%)was higher than that in the traditional group(81.08%),with statistically significant difference(χ^(2)=5.045,P<0.05).Testing the nutritional status of the postoperative patients,in postoperative comparison of nutritional indicators in the same period,the postoperative prealbumin in the observation group(0.43±0.07 g/L)was higher than that in the traditional group(0.31±0.07 g/L)(t=7.373,P<0.05).Postoperative transferrin in the observation group(3.16±1.03 g/L)was higher than that in the traditional group(1.97±0.53 g/L)(t=6.248,P<0.05).The postoperative albumin in the observation group(41.67±2.57 g/L)was higher than that in the traditional group(35.67±2.18 g/L)(t=10.829,P<0.05).The postoperative hemoglobin in the observation group(110.74±2.03)g/L was higher than that in the traditional group(105.43±2.53 g/L)(t=9.957,P<0.05).In the comparison of the complication rates,the observation group(2.70%)was lower than the traditional group(16.22%)(χ^(2)=3.944,P<0.05).The perioperative indicators in the observation group(surgical blood loss:256.34±12.26 mL,duration of digestive tract reconstruction:44.61±5.18 min,first exhaust time:2.95±0.65 d,the first food intake time:4.32±0.53 d)were lower than those in the traditional group(surgical blood loss:276.85±12.58 mL,duration of digestive tract reconstruction:49.74±5.57 min,first exhaust time:3.68±0.52 d,the first food intake time:5.46±1.03 d),with statistically significant difference(surgical blood loss:t=7.102,P<0.05;duration of digestive tract reconstruction:t=4.102,P<0.05;first exhaust time:t=5.334,P<0.05;the first food intake time:t=5.986,P<0.05).【Conclusion】The use of dual-channel jejunal interposition for gastrointestinal reconstruction in patients with gastric cancer after surgery is highly feasible and worthy of promotion.