全胃切除术后四种消化道重建术式的比较分析

目的 探讨全胃切除术后最适宜的消化道重建术式.方法 将2005年1月至2007年12月间天津医科大学附属肿瘤医院收治的159例胃肿瘤患者按全胃切除术后重建消化道方式的不同,分为A组（功能性连续空肠间置贮袋代胃,46例）、B组（改良BraunⅡ式,38例）、C组（P形空肠袢食管空肠Roux-en-Y吻合术,25例）和D组（Orr式空肠食管Roux-en-Y吻合术,50例）.比较4组患者术后1年生活质量、营养状况及并发症情况.结果 4组患者术后近期并发症发生率的差异无统计学意义（P＞0.05）.术后1年,A组患者生活质量（Visick分级指数）优于其他3组,而D组则劣于其他3组（均P＜0.05）.A组患者单餐进食量及体质量、血红蛋白、总蛋白增加幅度高于其他3组,而D组则低于其他3组（均P＜0.05）.4组患者预后营养指数比（PNIR）分别为1.21±0.15、1.14±0.97、1.15±0.16和1.10±0.16,A组高于其他3组,D组低于其他3组（均P＜0.05）.A组患者倾倒综合征、反流性食管炎、Roux-en-Y滞留综合征发生率分别为4.3%（2/46）、2.2%（1/46）和2.2%（1/46）,均显著低于其他3组（均P＜0.05）.结论 全胃切除术后功能性连续空肠间置贮袋代胃可有效改善患者营养、降低术后并发症、提高生活质量,是一种较好的消化道重建术式.

Comparative study on four different reconstruction procedures after total gastrectomy

Objective To investigate the optimal reconstruction technique after total gastrectomy. Methods A total of 159 patients with gastric cancer undergoing total gastrectomy in Tianjin Cancer Hospital between January 2005 and December 2007 were divided into 4 groups according to the reconstruction technique: group A (functional jejunal interposition with a pouch, n=46),group B (modified Braun type Ⅱ , n=38), group C (P pouch with Roux-en-Y esophagojejunostomy, n=25 ),group D(Roux-en-Y esophagojejunostomy,n=50). Quality of life(QOL), nutritional status 1 year after surgery, and perioperative complications were analyzed. Results There were no significant differences in perioperative complications (P＞0.05). One year after operation, QOL (Visick index) was better in group A than that in group B, C and D (P＜0.05), and group D was inferior to group A, B and C(P＜0.05). The increase in food intake, weight gain, hemoglobin and total protein were better in group A than those in group B, C and D(P＜0.05) and group D was inferior to group A, B and C(P＜0.05).The prognostic nutrition index ratio of the four groups were 1.21±0.15, 1.14±0.97, 1.15±0.16, and 1.10±0.16, respectively. Group A was better than that in group B, C and D (P＜0.05) and group D was inferior to group A, B and C (P＜0.05). The incidences of dunping syndrome, reflux esophagitis,Roux-en-Y stasis syndrome in group A were 4.3%(2/46), 2.2%(1/46) and 2.2%(1/46), respectively,which were significantly lower than those in other groups (P＜0.05). Conclusions Functional jejunal interposition with a pouch is associated with improved nutritional condition and quality of life, and less perioperative complications. It is a reasonable reconstruction method after total gastrectomy.