全胃切除术后不同代胃术式的评价

Evaluation of Different of Reconstruction after Total Gastrectomy.

目的:探讨胃癌全胃切除术后合理的消化道重建方式。方法:对459例行全胃切除术并随访1年以上的胃癌(除外Ⅳ期)病人,以6种不同的方式进行消化道重建,分别为襻式吻合、改良BraunⅠ式、改良BraunⅡ式、Roux鄄en鄄Y式、“P”型空肠间置和功能性空肠间置代胃术式。对各组病人以术后并发症、体重、营养状况、预后营养指数(PNI)、血红蛋白水平、代胃半排空时间及Visick指数进行对照观察。结果:各组比较以功能性空肠间置组在防反流方面和血清白蛋白水平上明显优于其他组(P<0.01)。“P”型空肠间置与功能性空肠间置食糜流经十二指肠,其体重维持、各项营养参数(PNI)均高于不间置组(P<0.05)。结论:消化道重建保持食物流经十二指肠,又保护好代胃空肠神经,生理功能完整,是选择代胃方式的基本原则;功能性空肠间置是值得推荐的代胃术式。

Objective:To quest for the optimum mode of reconstruction after total gastrectomy for malignant diseases.Methods:Among the459cases of total gastrectomy for malignant disease,6modes of reconstructions had been used;they were the Braun,the modified BraunⅠ(m BraunⅠ),the modified BraunⅡ(m BraunⅡ),the RouxenY,the'P'jejunal interposition and the functional jejunal interposition(FJI).Postoperative complications,body weight,food intake,serum nutritional paraments,complete blood count,halfemptying time of the gastric substitute,prognostic nutritional index(PNI)and Visick index were evaluated one year after surgery.Results:As compared with Braun group,the m BraunⅠ,Ⅱand RouxenY groups which had some kinds of gastric substitute showed less reflux esophagitis and higher serum total protein(P<0.01).As compared with m BraunⅠ,Ⅱand RouxenY,the PJI and FJI groups which had duodenal passage showed better body weight,higher nutritional paraments and PNI(P<0.05).Conclusions:It is essential to construct a gastric substitute and maintain the food chyme flowing through the duodenum after total gastrectomy,and the FJI is a better choice in this study.