全胃切除后四种代胃术近期疗效比较

目的 探讨全胃切除后合理的代胃术.方法 回顾性分析2007年10月～2012年11月在泰山医学院附属医院施行全胃切除的患者184例,按代胃方式不同将其分为四组:A组Roux-en-Y空肠代胃术132例,B组间置空肠代胃术18例,C组袢式空肠代胃术23例,D组Roux-en-Y双腔远端贮袋代胃术11例.通过比较术后一般并发症发生情况及消化道症状等资料,评价各代胃术的优缺点及近期疗效.结果 四组代胃术患者术后一般并发症发生率方面相比,无显著性差异(P＞0.05);术后消化道症状,袢式空肠代胃术组反流性食管炎发生率明显高于其他三组(P＜0.05),其他三组间相比,无显著性差异(P＞0.05);在腹胀、腹泻、倾倒综合征、Roux-en-Y滞留综合征等发生率方面,4组代胃术间相比,无显著性差异(P＞0.05).结论 Roux-en-Y空肠代胃术操作简单,近期疗效好,是全胃切除术后合理的代胃术.

Comparison of short-term therapeutic effects on four types of alimentary tract reconstructions after total gastrectomy

Objective To investigate the rational alimentary tract reconstruction after total gastrectomy. Methods From October 2007 to November 2012, data of 184 cases underwent total gastrectomy in affiliated hospital of Taishan Medi-cal College were analyzed retrospectively. According to reconstruction type, they were divided into four groups： A group （132 cases） Roux-en-Y anastomosis, B group （18 cases） jejunal interposition, C group （23 cases） loop-type anastomosis, D group （11 cases） Roux-en-Y double-cavity anastomosis. By analyzing their postoperative complications and the incidence rate of digestive symptom, we could observe the qualities and defects of different anastomosis and short-term therapeutic effects. Results There were no significant differences in 4 groups among postoperative complica tions （P 〉 0.05）. The incidence rate of reflux esophagitis in loop-type anastomosis group was higher than other groups （P 〈 0.05）, and had no statistical difference among the other 3 groups （P 〉 0.05）. The incidence rate of abdominal dis- tension,diarrhoea, dumping syndrome, Roux-en-Y stasis syndrome had no statistical difference （P 〉 0.05）. Conclu-sion Roux-en-Y anastomosis had the merits of easy operation, few postoperative complications, was the rational ali mentary tract reconstruction after total gastrectomy.