胃次全切除术后不同消化道重建方式对胃癌患者血浆ghrelin水平的影响

目的探讨胃次全切除术后不同的消化道重建方式对血浆ghrelin水平的影响,以及ghrelin与BMI之间的关系。方法收集81例行根治性手术的T1-3N0M0远端胃癌患者,根据消化道重建方式的不同分为毕Ⅰ式组（30例）、毕Ⅱ式组（25例）和Roux—en—Y组（26例）。分别在术前、术后1d、1周、半年及1年测定血浆ghrelin水平及BMI。结果术后1d,毕Ⅰ式、毕Ⅱ式和Roux-en-Y3组患者ghrelin水平分别为术前水平的（34．2±5．2）％、（37．7±4．7）％和（36．5±4．9）％;术后1周分别为（52．6±6．5）％、（48．3±5．7）％和（48．1±6．0）％,3组比较差异均无统计学意义（均P〉0．05）。术后半年,3组患者ghrelin水平分别为术前水平的（91．7±7．5）％、（80．4±8．1）％和（75．3±8．3）％;术后1年分别为（95．3±5．1）％、（84．5＋6．3）％和（79．9±6．7）％;毕Ⅰ式组ghrelin水平显著高于其他两组（均P〈O．01）,毕Ⅱ式组高于Roux-en—Y组均（P〈0．05）。术后1年3组患者BMl分别下降了（2．1±1．1）％、（4．5±1．9）％和（5．7±1．8）％,差异有统计学意义（P〈0．05）：3组患者ghrelin下降幅度与BMI下降幅度均存在线性相关（均P〈0．01）。结论符合解剖生理的毕Ⅰ式消化道重建更加有利于术后血浆ghrelin水平的代偿性恢复;胃次全切除术后血浆ghrelin水平的下降是导致患者体质量减轻的重要原因。

Influence of digestive tract reconstruction techniques on plasma ghrelin level and body mass index after subtotal gastectomy

Objective To study the impact of digestive tract reconstruction techniques on plasma ghrelin level and body mass index (BMI) after subtotal gastectomy.Methods Eighty-one patients undergoing subtotal gastrectomy for T1-3N0M0 gastric cancer were divided into three groups according to digestive tract reconstruction techniques, which included Billroth I group (n=30), Billroth II group(n=25) and Roux-en-Y group(n=26). Plasma ghrelin level was determined by radioimmunoassay preoperatively and one day, one week, half a year, and one year after gastrectomy. BMI was similarly recorded.Results Plasma ghrelin levels of three groups decreased sharply to nadir one day after operation, which were (34.2±5.2)%, (37.7±4.7)% and (36.5±4.9)% respectively. A week after operation they were (52.6±6.5)%, (48.3±5.7)% and (48.1±6.0)%. There were no statistical difference between groups(P=0.075). Half a year postoperatively, they were (91.7±7.5)%, (80.4±8.1)% and (75.3±8.3)% and a year postoperatively(95.3±5.1)%, (84.5±.63)% and (79.9±6.7)%, showing that Billroth I group was obviously higher than the other two groups (P<0.01) and Billroth II group was higher than Roux-en-Y group (P<0.05). BMI of three groups at a year after surgery descended by (2.1±1.1)%, (4.5 ±1.9)% and (5.7 ±1.8)% respectively, demonstrating statistical difference. Linear regression correlation existed in the three groups between decreasing amplitude of ghrelin and BMI (P<0.01). Conclusions Billroth I digestive tract reconstruction takes on the normal anatomy and physiology and therefore promotes compensatory ghrelin secretion. Falling of ghrelin level greatly contributes to the weight loss after subtotal gastrectomy.