全胃切除横结肠代胃术在胃癌治疗中的应用

目的：探讨全胃切除横结肠代胃术在胃癌治疗中的应用价值。方法：193例胃癌患者随机分为对照组与观察组，对照组采用传统食管/空肠Schlatter吻合术或食管/空肠Roux-en-Y吻合术重建消化道，观察组以横结肠代胃术重建消化道。比较两组术前、术后第1，9天T细胞亚群和IL-2及急性炎症介质的变化、术后病死率、并发症发生率、住院时间。结果：术前及术后第1天，两组各项指标差异均无统计学意义（均P>0.05）；术后第9天，与对照组比较，观察组CD4+细胞比例，CD4+/CD8+，IL-2水平明显升高，而CD8+T细胞比例，IL-6， C-反应蛋白（CRP）水平明显降低（均P<0.05）；两组术后病死率、并发症发生率差异无统计学意义（P>0.05），而观察组平均住院时间明显少于对照组（P<0.05）。结论：横结肠代胃术是一种安全的消化道重建新术式，对改善胃癌患者术后的免疫功能具有积极意义。

Transverse colon interposition for gastric reservoir following total gastrectomy for gastric cancer

Objective: To investigate the application value of transposition of a transverse colon segment for gastric replacement after total gastrectomy in treatment of gastric carcinoma. Methods: One hundred and ninety-three gastric cancer patients requiring total gastrectomy were randomly divided into control group and observation group. Patients in control group underwent the conventional Schlatter’s or Roux-en-Y esophagojejunostomy for digestive tract reconstruction, while those in observation group received gastric reservoir construction of transverse colon transposition after total gastrectomy. The alterations in T-lymphocyte subsets, IL-2 level, and mediators of acute inflammation before operation and at postoperative day (POD) 1 and 9, as well as the mortality, incidence of postoperative complications and length of hospital stay between the two groups were compared. Results: There were no significant differences between the two groups in all parameters before operation and at POD 1 (all P>0.05). At POD 9, the percentage of CD4+ T cells, ratio of CD4+ to CD8+ T cells and IL-2 level in observation group were significantly increased, but the percentage of CD8+ T cells and levels of IL-6 and C-reactive protein (CRP) were significantly decreased compared with control group (all P>0.05). No differences were noted in postoperative death and incidence of postoperative complications between the two groups (both P>0.05), however, the average length of hospital stay in observation group was significantly shorter than that in control group (P<0.05). Conclusion: Transverse colon interposition for gastric reservoir is a safe procedure for reconstruction of alimentary tract, which is beneficial for improving the postoperative immune function in gastric cancer patients.