不同连续性空肠间置代胃术用于胃癌根治术的效果观察

目的观察不同连续性空肠间置代胃术（CJI）用于胃癌根治术的效果，探讨应用CJI的适应证。方法根据胃全切除或次全切除后的具体情况，45例胃癌患者在根治术中采用CJI重建消化道，空肠分别被间置于食管和十二指肠之间（A组15例）、食管和远端残胃之间（B组14例）以及近端残胃和十二指肠之间（C组16例）。观察患者术后半年内营养指标的变化（包括体重、血红蛋白、血浆总蛋白和前白蛋白）和进食的情况（包括每El进食次数、每次进食量），并作内镜检查观察是否有反流性食管炎的发生。结果A、C两组患者术后6个月时各营养指标均有改善，并以C组最明显（P〈0．05）。3组患者的进食情况以C组最佳，而反流性食管炎在A、B两组中的发生率较高，尤其是B组（P=0．000）。结论CJI虽然使胃癌患者在根治术后的食物通路更符合生理，但在消化道重建时并非总是最佳的选择，应提倡根据术中的具体情况个体化应用CJI。

Evaluation of different modalities of continual jejunal interposition applied in radical correction of gastric cancer

Objective To evaluate the different modalities of continual jejunal interposition （CJI）, applied in radical correction of gastric cancer. Methods According to the conditions after total gastrectomy or subtotal gastrectomy, CJI was performed in 45 patients undergoing radical correction of gastric cancer. Jejunums were interposed to take the place of the removed stomach between esophagus and duodenum （group A, n=15）, esophagus and distal gastric stump （group B, n=14）, proximal gastric stump and duodenum （group C, n=16）. The nutritional indexes （include body weight and hemoglobin and plasma total protein and prealbumin） and food intake conditions （include frequency per day and quantity per time） were observed during six months after operation, and reflux esophagitis was also observed by endoscopy. Results The nutritional indexes of group A and C were improved at six months after operation especially in group C （P〈0.05）. Reflux esophagitis occurred more frequently in group A and B especially in group B （P=0.000）. Conclusion Continual jejuna interposition is applied to restore food path for patients undergoing radical correction of gastric cancer, the choosing of different modalities should be individualized.