全胃切除三种不同消化道重建后的临床疗效观察

Clinical Observation on the Efficacy of Three Different Reconstructive Methods of Alimentary Canal for Total Gastrectomy

目的 探讨胃恶性肿瘤行全胃切除后不同消化重建术式的临床效果。方法 67例胃恶性肿瘤行全胃切除术后采用3种不同的消化道重建方式 ,对其术后半年饮食状况、消化道症状和营养指标等进行观察。结果 三种术式患者 6个月后并发症 :SS型与P型空肠间置吻合术两组间比较总并发症发生率P值 <0 0 5 ( χ2 检验 ) ,而SS型和P型空肠间置吻合与Roux -en -Y或La hey +Broun吻合术 (R/或L)组三组间比较结果 ,R/或L总并发症发生率P <0 0 1( χ2 检验 )。三组术后 6个月的体重、血红蛋白、血清总蛋白和血清白蛋白指标 ,其数据经统计学处理 (t检验 ) ,三组间比较差异无显著性意义。结论 全胃切除术采用SS型和P型间置空肠代胃 ,恢复食物经过十二指肠通道 。

Objective To compare the clinical effects of different reconstructive modes of alimentary canal for total gastrectomy. Methods 67 cases of the patients with gastric malignant tumor received total gastrectomy and alimentary canal restruction of SS loop /Roux_Y, P loop/Roux_Y or Roux_Y. The diety complaint, digestive tract symptom and the nutritional status of the patients were investigated 6 months after operation. Results Compared with Roux_Y or Lahey+Broun mode,the complication frequency of SS loop /Roux_Y and P loop/Roux_Y modes was significantly lower(P<0 01). The differences of body weight, hemoglobin, total serum proteins and serum albumin 6 months after operation in three operative modes were not significant. Conclusion The jejunal interposition for stomach reconstruction of SS and P types is sensible reconstruction after total gastrectomy. It can improve quality of life, reduce complications and maintain the canal of the chyme through the duodenal tract.