空肠间置吻合术在近端胃癌全胃切除术中的应用及对患者胃肠功能的影响

目的探讨空肠间置吻合术在近端胃癌全胃切除后消化道重建中的效果及对患者消化功能的影响。 方法回顾性分析2016年4月至2018年8月实施胃癌根治术的80例近端胃癌患者资料，其中行空肠间置吻合术实施消化道重建的40例患者纳入观察组，行食管－空肠Roux－en－Y进行消化道重建的40例患者纳入对照组。采用SPSS16.0分析统计，手术相关情况及胃肠激素水平等计量资料用( ±s)描述，组间比较独立t检验，组内比较配对t检验；术后并发症比较采用χ²检验；P<0.05差异有统计学意义。 结果两组手术时间、术中出血量、清扫淋巴结数目、住院时间比较，差异无统计学意义(P>0.05)。术后3个月，两组血清胃泌素(GAS)、胃动素(MTL)、生长抑素(SS)水平均比术前明显下降，且对照组下降更为显著；胆囊收缩素(CCK)水平均较术前明显升高，差异均有统计学意义(P<0.05)。观察组的并发症率10.00%低于对照组的27.50%(χ²＝4.021, P＝0.045)。 结论空肠间置吻合术在胃癌根治术后消化道重建中对患者消化功能影响较小，患者术后并发症发生率更低。

Application of jejunal interposition anastomosis in total gastrectomy for proximal gastric cancer and its effect on gastrointestinal function

ObjectiveTo investigate the effect of jejunal interposition anastomosis in digestive tract reconstruction after total gastrectomy for proximal gastric cancer and its effect on digestive function of patients. Methods80 patients with proximal gastric cancer who underwent radical total gastrectomy in our hospital from April 2016 to August 2018 were selected. 40 patients who underwent gastrointestinal reconstruction by jejunal interposition anastomosis were included in the observation group, and 40 patients who underwent gastrointestinal reconstruction by esophago-jejunal Roux-en-Y were included in the control group. All the data were analyzed by SPSS 16.0. The operation-related data and gastrointestinal hormone levels were described by ( ±s), the independent sample t test was used for comparison between the two groups, and the paired t test was used for comparison at different time. The counting data were compared by χ² test; P<0.05 had statistical significance. ResultsThere was no significant difference in operation time, intraoperative bleeding volume, number of lymph nodes dissected and length of hospital stay between the two groups (P>0.05). Three months after operation, the levels of serum gastrin (GAS), motilin (MTL) and somatostatin (SS) in the two groups were significantly lower than those before operation, and the decrease in the control group was more significant, the level of cholecystokinin (CCK) was significantly higher than that before operation, the differences were statistically significant (P<0.05). The complication rate of the observation group was 10.00%, which was lower than that of the control group of 27.50% (χ²=4.021, P=0.045). ConclusionJejunal interposition anastomosis has less influence on digestive function and lower incidence of complications after radical total gastrectomy for proximal gastric cancer.