胃癌根治术后3种消化道重建术的对比研究

目的:探讨胃癌根治术后3种不同消化道重建术式的应用效果。方法:回顾性分析我院2007年5月—2011年9月完成的胃癌手术147例,按消化道重建方式不同分为袢式Braun吻合术组、Roux-en-Y食管(胃)空肠吻合术组、改良Roux-en-Y食管(胃)空肠吻合术组(改良组)。比较各组患者消化道重建时间、术后并发症发生率及术后1年Visick分级指数。结果:所有病例均顺利完成手术,无手术死亡。消化道重建吻合完成时间Roux-en-Y吻合术组长于Braun吻合术组和改良组。Braun吻合术组的吻合口溃疡、碱性反流胃炎、倾倒综合征发生率均明显高于Roux-en-Y吻合术组及改良组,差异有统计学意义(P<0.05);而Roux-en-Y吻合术组的Roux-en-Y滞留综合征发生率明显高于改良组,差异有统计学意义(P<0.05);术后1年Visick分级改良组Ⅰ级例数明显高于另外两组,Ⅲ级例数明显低于另外两组,差异有统计学意义(P<0.05)。结论:改良Roux-en-Y食管(胃)空肠吻合术能明显改善患者的生活质量,是胃癌术后消化道重建较合适的术式。

Comparative study of three digestive tract reconstructions after resection of gastric cancer

Objective： To investigate the efficacy of three different methods of digestive tract reconstruction after gastric cancer surgeon. Methods： 147 cases were reviewed during May 2007 to Sep 2011 Of which three types of digestive reconstruction were performed after gastric cancer surgeon. According to the different digestive reconstruction ,they were divided into loop type Braun anastomosis group （group A）, Roux-en-Y esophago （gastro）-jejunostomy group （group B） and modified Roux-en-Y esophago（gastro）- jejunostomy group（group C）, The digestive reconstruction time,incidence of postoperative complication,visick score after 1 year were compared. Results： All cases were finished the operation and no patient died. The time of digestive reconstruction spent from group B was longer than group A and group C, Group A was significantly higher than group B and C in the incidence of marginal ulcer,alkaline reflux gastritis and dumping syndrome（P〈0.05）, Group B was significantly higher than group C in the incidence of Roux-en-Y stasis syndrome; The number of cases scored visick Ⅰ from group C was significantly higher than from the other two groups, but the number scored visick Ⅲ from group C was significantly lower than from the others. Conclusion： Modified Roux-en-Y esophago （gastro）-jejunostomy is an adoptable method of di-gestive tract reconstruction for gastric cancer because it can provide patients better quality of life.