改良空肠间置术在近端胃癌根治术中应用的临床研究

目的：探讨改良空肠间置术在近端胃癌根治术中应用价值。方法：选取我院择期行近端胃癌根治术患者65例，根据不同消化道重建方式将患者分为观察组（30例，行改良空肠间置术）和对照组（35例，行食管残胃吻合术），比较两组患者手术时间、术中出血量、术后并发症、术后2月后营养、体重状况和反流性食管炎症状差异。结果：观察组手术时间明显高于对照组，两组比较差异具有统计学意义（P〈0.05）；两组患者术中出血量、术后并发症（肺部感染、导管相关性感染、全身炎症综合征、吻合口瘘）比较差异无统计学意义（P〉0.05）；术后2个月观察组患者血红蛋白水平、总淋巴细胞计数均明显高于对照组，体重变化评分、反流严重程度评分均明显低于对照组，两组比较差异均具有显著性（P〈0.05），但两组血清白蛋白水平、预后营养指标比较差异无显著性（P〉0.05）。结论：与对照组相比，改良空肠间置术能明显改善患者营养和反流症状，可应用于近端胃癌根治术患者的消化道重建。

Clinical study on the application of modiifed jejunal interposition in proximal gastric cancer radical surgery

Objective： To investigate the application value of modiifed jejunal interposition in proximal gastric cancer radical surgery. Methods：Sixty-ifve cases of patients with gastric cancer, who were undergoing proximal gastrectomy in our hospital, were selected and divided into an observation group （30 cases with modiifed jejunal interposition） and a control group （35 cases with esophagogastrostomy） based on the different procedures of alimentary tract reconstruction, and operation time, intraoperative bleeding volume, postoperative complications, nutrition and weight status and the symptoms of relfux esophagitis were compared between two groups. Results：The operation time was much longer in the observation group than in the control group, which showed a statistical significance （P〈0.05）, however, the comparisons of the bleeding volume, postoperative complications （pulmonary infection, catheter related infection, systemic inflammatory syndrome, anastomotic fistula） had no statistical signiifcance （P〉0.05）. Hemoglobin level and total lymphocyte count after two months of operation were signiifcantly higher in the observation group than in the control group, while the change of body weight and the score of regurgitation severity were signiifcantly lower in the observation group than in the control group, the differences were signiifcant （P〈0.05）. However, the comparisons of serum albumin level and prognostic nutritional index were not signiifcantly different （P〉0.05）. Conclusion：The modiifed jejunal interposition operation can obviously improve the nutrition and relfux symptoms of patients and be applied to the reconstruction of digestive tract in the patients undergoing proximal gastrectomy.