根治性近端胃切除联合双通道重建术对胃癌患者围术期指标及营养指标的影响

The effect of radical proximal gastrectomy combined with dual-channel reconstruction on perioperative and nutritional indicators in gastric cancer patients

目的分析根治性近端胃切除联合双通道重建术对胃癌患者围术期指标及营养指标的影响。方法选取胃癌患者60例,随机分为对照组和观察组,各30例。对照组行根治性全胃切除术+Roux-en-Y消化道重建术,观察组行根治性近端胃切除联合双通道重建术。对比两组的围术期指标、术后恢复情况、营养指标、生活质量、并发症发生情况。结果观察组术中出血量(89.65±10.21)ml少于对照组的(105.31±17.45)ml,手术时间(116.27±13.34)min、消化道重建时间(32.25±3.71)min、住院时间(8.35±1.36)d、肠鸣音恢复时间(25.36±2.59)h、肛门排气时间(43.26±5.46)h、进流食时间(84.36±6.87)h、下床活动时间(52.43±5.24)h均短于对照组的(139.84±16.25)min、(39.87±5.31)min、(10.69±1.87)d、(31.48±3.37)h、(54.89±7.58)h、(98.57±8.33)h、(59.67±6.57)h(P<0.05)。术后,两组血红蛋白(Hb)、总蛋白(TP)、白蛋白(ALB)均较术前降低,但观察组Hb(116.57±11.69)g/L、TP(67.35±4.89)g/L、ALB(40.56±4.71)g/L均高于对照组的(101.35±9.75)、(61.26±3.67)、(33.48±3.69)g/L(P<0.05)。术后,两组躯体疼痛、生理职能、生理机能、一般健康状况、精力、社会功能、情感职能、精神健康评分均较术前升高,且观察组较对照组更高(P<0.05)。观察组并发症发生率为6.67%(2/30),低于对照组的26.67%(8/30)(P<0.05)。结论对胃癌患者行根治性近端胃切除联合双通道重建术具有创伤小、术后恢复快等优势,还可改善患者营养状态,提高生活质量,且无严重并发症,临床可推行应用。

Objective To analyze the effect of radical proximal gastrectomy combined with dualchannel reconstruction on perioperative and nutritional indicators in gastric cancer patients.Methods 60 cases of gastric cancer patients were selected and randomly divided into a control group and an observation group,with 30 cases in each group.The control group underwent radical total gastrectomy+Roux-en-Y reconstruction,while the observation group underwent radical proximal gastrectomy combined with dual-channel reconstruction.Comparison was made on perioperative indicators,postoperative recovery,nutritional indicators,quality of life,and complications between the two groups.Results The intraoperative blood loss of(89.65±10.21)ml in the observation group was less than(105.31±17.45)ml in the control group;in the observation group,the operation time was(116.27±13.34)min,the digestive tract reconstruction time was(32.25±3.71)min,the hospital stay time was(8.35±1.36)d,the bowel sound recovery time was(25.36±2.59)h,the anal exhaust time was(43.26±5.46)h,and the liquid feeding time was(84.36±6.87)h,and the off-bed activity time was(52.43±5.24)h,which were shorter than(139.84±16.25)min,(39.87±5.31)min,(10.69±1.87)d,(31.48±3.37)h,(54.89±7.58)h,(98.57±8.33)h,and(59.67±6.57)h in the control group(P<0.05).After surgery,the hemoglobin(Hb),total protein(TP)and albumin(ALB)in both groups were lower than those before surgery;the observation group had Hb of(116.57±11.69)g/L,TP of(67.35±4.89)g/L and ALB of(40.56±4.71)g/L,which were higher than(101.35±9.75),(61.26±3.67)and(33.48±3.69)g/L in the control group(P<0.05).After surgery,the scores of bodily pain,role-physical,physical function,general health status,energy,social function,role-emotional and mental health in both groups were higher than those before surgery,and the observation group was higher than the control group(P<0.05).The incidence of complications in the observation group was 6.67%(2/30),which was lower than 26.67%(8/30)in the control group(P<0.05).Conclusion Radical proximal gastrectomy combined with dual-channel reconstruction has advantages such as minimal trauma and fast postoperative recovery,which can improve the nutritional status and quality of life of gastric cancer patients without serious complications.It can be promoted and applied clinically.