近端胃癌患者根治性切除术后三种消化道重建方式的对比研究

目的比较胃底贲门癌患者根治性胃切除术后不同消化道重建术式的反流性食管炎发生情况及生活质量。方法前瞻性人组2010年2月至2011年8月间河南省肿瘤医院收治的、拟行根治性胃切除的123例胃底贲门癌患者，按照随机数字表法分为3组，每组41例，在根治性胃切除术后分别行空肠间置吻合术、食管残胃后壁吻合术及食管空肠Roux-en-Y吻合术。分别于术前和术后1月行胃排空试验和食管下段pH值测定以评估患者食管反流情况．追踪肝肾功能及血常规变化情况：于术前和术后12月评估患者肝肾功能及生活质量。结果3组患者手术前、后血常规和肝肾功能指标的变化均无统计学意义（均P〉0．05）。术后空肠间置吻合组、食管残胃后壁吻合组和食管空肠Roux—en—Y吻合组分别有1例（2．4％）、10例（24．4％）和7例（17．1％）患者出现反流性食管炎症状，差异具有统计学意义（P=0．017）；分别有1例（2．4％）、7例（17．1％）和8例（19．5％）患者于上消化道钡餐造影检查时发现钡剂反流入食管，差异有统计学意义（P=0．046）；食管下段pH值分别为6．9±0．2、6.8±0．1和6．9±0．1，差异无统计学意义（P=0．196）。术后1年，3组患者在整体健康状况、躯体功能、情绪功能、疲劳、恶心呕吐、疼痛症状、便秘及腹泻方面的生活质量评分明显优于术前（均P〈0．05）；空肠间置吻合组患者在整体健康状况、情绪功能、恶心呕吐、便秘及腹泻方面的生活质量评分显著优于其他两组（均P〈0．05）。结论近端胃癌患者根治性胃切除术后采用空肠间置吻合术、食管残胃后壁吻合术及食管空肠Roux—en—Y吻合术均能够满足消化道重建的需要，能够有效地改善患者的生活质量；其中空肠间置吻合重建术在减少反流性食管炎的发生和提高患者生活质量方面的效果更为显著，是比较理想的近端胃癌根治术后消化道重建术式。

Comparison study of three methods of digestive tract reconstruction after radical gastrectomy in gastric cancer patients

Objective To investigate the ideal digestive tract reconstruction methods among three different surgical methods after radical gastrectomy of gastric cancer patients. Methods A total of 123 patients who received elective radical gastrectomy for gastric cancer from February 2010 to August 2011 were prospectively enrolled and randomly divided into radical proximal gastrectomy and jejunal interposition group, radical proximal gastrectomy and esophageal with the posterior of residual-stomach group, and radical total gastrectomy and Roux-en-Y esophagojejunostomy group. Patients were followed up for 12 months. Symptoms of reflux esophagitis were observed, gastric emptying tests were done, liver and kidney function was also monitored. The quality of life was documented before operation, and one and twelve months after operation. Results No significant differences were found among these three groups in the pH value of lower part of esophagus, the blood regular test results and the functional parameters of kidney and liver before and after operation（all P〉0.05）. Symptoms of reflux esophagitis was reported in 1（2.4%） patients in the jejunal interposition group, 10（24.4%） in esophageal with the posterial of residual-stomach group, and 7（17.1%）in the Roux-en-Y esophagojejunostomy group（P=0.017）. There was 1 （2.4%）, 10 （17.1%）, and 8 （19.5%） patients presented reflux of barium meal in these three groups, respectively （P=0.046）. There were no statistically significant difference in PH at the distal esophagus （6.9±0.2 vs. 6.8±0.1 vs. 6.9±0.1, P=0.196）. The quality of life was significantly improved one year after surgery in terms of general status, physical function, emotional function, fatigue, nausea/vomiting, pain, constipation, and diarrhea （all P〈0.05）, with the jejunal interposition superior than the other two methods. Conclusion Three methods of digestive tract reconstruction in radical gastrectomy of gastric cancer patients can improve the health status and the quality of life in gastric cancer patients. Radical proximal gastrectomy and jejunal interposition is the preferred method.