胃癌全胃切除后不同消化道重建术式对消化吸收功能的影响

目的探讨胃癌全胃切除术不同消化道重建方式对术后消化吸收功能的影响。方法对108例胃癌患者全胃切除后消化道重建方式分别采用常规食管空肠Roux-en-Y吻合术43例、P型空肠襻食管空肠Roux-ell-Y吻合术41例和空肠贮袋食管空肠Roux-en-Y吻合术24例。观察术后3、12个月患者的营养状况和胃肠道症状GSPS评分等。结果术后3个月、12个月P型空肠襻组与常规组比较术后进食量增加P〈0．01，而GSPS评分降低P〈0．01，胃肠道症状发生几率降低。空肠贮袋组术后3个月、12个月进食量同样优于常规组P〈0．01，GSPS评分降低P〈0．01。且术后12个月P型空肠襻组与空肠贮袋组体重恢复较常规组更佳P〈0．01。而术后12个月空肠贮袋组在患者进食量又优于P型空肠襻组P〈0．01，体重恢复差异有统计学意义P〈0．01。结论P型空肠襻和空肠贮袋食管空肠Roux-en-Y吻合术有利于维持患者术后的消化吸收功能，而行空肠贮袋在某些方面又优于P型空肠襻。

Effect of three various procedures of alimentary reconstruction after total gastrectomy on postoperative digestive and absorptive function

Objective To make comparative analysis about digestive and absorptive functions of patients receiving Roux-en-Y procedures of alimentary reconstruction after total gastrectomy.Methods The clinical data of 108 patients who underwent total gastrectomy with 3 Roux-en-Y procedures of alimentary reconstruction were analyzed retrospectively. Three procedures of the reconstruction including general Roux-en-Y esophagojejunostomy (n=43), P-type jejunal loop Roux-en-Y (n=41) and jejunal pouch Roux-en-Y (n=24), were performed. Digestive and absorptive functions were assessed by gastrointestinal symptom rating scale (GSRS), nutritional parameters, endoscopic examination were evaluated at 3, and 12 months after surgery.Results The procedures of P-type loop and jejunal pouch reconstruction provided better digestive and absorption functions than Roux-en-Y reconstruction in a short-term period (at 3 and 12 months after operation), specially eating capacity and GSPS score (P < 0. 0 5 ). At 12 months after surgery, body weight recovery in the jejunal pouch group was significantly superior to that in the P-type loop group. Conclusions The procedures of P-type loop and jejunal pouch reconstruction may provide better digestive and absorption functions for patients undergoing total gastrectomy as compared with Roux-en-Y esophagojejunostomy. Jejunal pouch reconstruction provides further improvement of digestive and absorption functions in patients receiving total gastrectomy.