全胃切除术后不同消化道重建术式对胃癌患者生活质量及疗效的影响

Effects of different reconstruction procedures after total gastrectomy on quality of life and prognosis

目的探讨不同消化道重建方式对胃癌患者全胃切除术后生活质量、营养状态及生存率的影响。方法对283例行全胃切除术的患者,主要以袢式Braun吻合(Lahey法组)、“9(P)”字空肠袢Roux-en-Y吻合[9(P)Y组]及“P”字空肠袢间置代胃(PI组)进行消化道重建,并对各组患者术后生活质量和疗效进行对照观察。结果9(P)Y组与Lahey法组相比,前者Roux-en-Y潴留综合征(RSS)发生率高(14.5%,P<0.05),后者反流性食管炎发生率高(14.9%,P<0.05),9(P)Y组VisickⅠ～Ⅱ级比例(93.0%)显著高于Lahey法组(76.1%)(P<0.001)。术后6个月,9(P)Y组体重、总蛋白(TP)、血红蛋白(Hb)下降程度均低于Lahey法组(P<0.001及P<0.05),预后营养指数(PNI)则高于Lahey法组(P<0.001);术后1年时,9(P)Y组仅食量及体重下降低于Lahey法组(P<0.05及P<0.001)。PI组术后无反流性食管炎、RSS、腹泻、倾倒综合症发生,均为VisickⅠ～Ⅱ级;术后6个月至1年时,PI组食量、TP、Hb下降程度不明显,PNI指数则高于9(P)Y组。283例患者总的1、3、5年生存率分别为73.5%、37.4%和23.1%,各重建方式间生存率差异无显著性意义(P>0.05)。结论“P”字空肠袢间置代胃是全胃切除后较为合理的消化道重建术式。

Objective To compare the effects of different reconstruction procedures after total gastrectomy on quality of life, nutritional status and prognosis. Methods After total gestrectomy, Laheys anastomosis, 9(P) loop/Roux en Y or P loop interposition esophagojejunostomy were performed in 283 cases. The early and late complications,nutritional status and the survival rates were compared between three groups of different reconstruction types.Results As compared with Braun group, the incidence of Roux en Y stasis syndrome(RSS) was higher(14.5%,P< 0.05),but reflux esophagitis was less common(P< 0.05). The proportion of the patients with Visick Ⅰ and Ⅱ was higher(93.0% vs 76.1%,P< 0.001). Weight loss, decreased of total protein(TP) and hemoglobin(Hb) were less, while prognostic nutritional index(PNI) was higher in 9(P) loop/Roux en Y group at 6 months after operation. At 1 year after operation, only food intake and weight loss were lower(P< 0.05 and P< 0.001). No reflux esophagitis, RSS, diarrhea and dumping syndrome occurred in P loop interposition group. From 6 months to one year postoperatively, decrease of food intake,TP and Hb were less, but PNI was higher in P loop interposition group than those in 9(P) loop/Roux en Y group(P< 0.05). The overall 1 , 3 , 5 year survival rates were 73.5%, 37.4%, 23.1% respectively, and there was no difference in survival between these 3 groups of reconstruction procedure. Conclusions P loop interposition is a better reconstruction procedure after total gastrectomy, which can improve postoperative quality of life and nutritional status.