双通道重建手术与全胃切除术对胃癌患者术后营养状况的影响

目的 探讨胃体上部早期恶性肿瘤外科手术中不同消化道重建方式对患者术后营养状况的影响。方法 回顾性分析2016年6月至2018年1月于我院胃肠外科接受手术治疗的109例早期胃上部癌患者的病例资料。根据消化道重建方式将患者分为两组：双通道组（接受双通道重建手术，59例）和全胃组（接受全胃切除术，50例）。比较两组患者住院期间（入院时，术后第1、3、5天，出院时）及术后1年的实验室营养指标（血红蛋白、总蛋白、白蛋白、前白蛋白），以及术后1年体质量变化情况。结果 两组患者年龄、性别、入院时体质量、入院时实验室营养指标（血红蛋白、总蛋白、白蛋白、前白蛋白）、手术时间、手术方式、肿瘤位置、肿瘤最大径、肿瘤分化程度的差异均无统计学意义（P均>0.05）。术后第3天全胃组白蛋白低于双通道组，差异有统计学意义（t=2.30，P=0.023），术后第1、3、5天和出院时两组血红蛋白、总蛋白、前白蛋白水平差异均无统计学意义（P均>0.05）；出院时双通道组和全胃组血红蛋白、总蛋白、白蛋白、前白蛋白水平均较入院时下降，差异均有统计学意义（P均<0.05）。术后1年两组各实验室营养指标差异均无统计学意义（P均>0.05），而双通道组体质量下降百分比低于全胃组-10.45%（-17.11%，-5.19%）vs-17.83%（-22.06%，-13.10%）]，差异有统计学意义（Z=4.31，P<0.01）。结论 对于早期胃上部癌患者，双通道重建手术相比全胃切除术能够改善患者的营养状况。

Effects of double-tract reconstruction versus total gastrectomy on nutritional status in patients with gastric cancer

Objective To explore the influence of different reconstruction methods of digestive tract on postoperative short-term nutritional status of patients with early malignant tumor in upper gastric body. Methods Retrospective analysis was conducted on 109 patients with early upper gastric cancer who underwent surgical treatment in our hospital from Jun. 2016 to Jan. 2018. Double-tract reconstruction was performed in 59 patients (double-tract reconstruction group), and total gastrectomy was performed in 50 patients (total gastrectomy group). Nutritional indexes (hemoglobin, total protein, albumin and prealbumin) were compared between the two groups during hospitalization (at admission, 1, 3, 5 days after operation, and at discharge) and one year after operation. The changes in body weight were observed in the first year after operation. Results There were no significant differences in age, gender, body weight or nutritional indexes (hemoglobin, albumin, total protein, prealbumin) at admission, operation time, operation method, tumor location, tumor maximum diameter, or tumor differentiation between the two groups (P>0.05). On the 3^rd day after the operation, albumin in the total gastrectomy group was significantly lower than that in the double-tract reconstruction group (t=2.30, P=0.023). There were no significant differences in the hemoglobin, total protein or prealbumin between the two groups on day 1, 3 and 5 after operation, and at discharge (P>0.05). The levels of hemoglobin, total protein, albumin and prealbumin were significantly decreased in both groups at discharge as compared with that at admission (P<0.05). At 1 year after the operation, there was no significant difference in the nutritional indexes between the two groups (P>0.05). But the body weight loss in the double-tract reconstruction group was significantly lower than that in the total gastrectomy group (-10.45%-17.11%, -5.19%) vs -17.83%-22.06%, -13.10%], Z=4.31, P<0.01). Conclusion In comparison to total gastrectomy, double-tract reconstruction surgery can effectively improve the nutritional status of patients with early upper gastric cancer.