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目的:全胃切除术后常常会发生明显的营养不良、各种术后不良症状以及生活质量的下降。本研究通过对比全胃切除术后四种消化道重建方式,探讨全胃切除术后理想的消化道重建术式。方法:选取自2007年11月至2011年3月间我院行全胃切除术治疗胃癌患者196例,分为A组(行功能性空肠间置代胃术)、B组(P型空肠间置代胃术)、C组(P型Roux-en-Y空肠代胃术)、D组(改良Longmire法空肠代胃术)4种消化道重建术。比较4组患者手术时间、出血量、住院时间和死亡率以及术后1年生活质量、营养状况和术后并发症情况。结果:4组患者在平均手术时间、出血量、住院时间和死亡率方面无明显差异(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2.1%(1/48)、4.2%(2/48)和2.1%(1/48),均显著低于其他3组(均P<0.05)。术后1年生活质量(Visick分级指数)的比较,A组明显优于其他3组(均P<0.05)。术后1年营养预后指数(PNI)分别为55.40±3.6,52.30±2.8,41.5±4.3和40.7±5.5,A组和B组明显高于C组和D组(P<0.05),A组和B组组间数据差异无统计学意义(P>0.05),C组和D组组间数据差异无统计学意义(P>0.05)。结论:全胃切除术术后消化道重建应保持空肠的连续性并保持摄入食物通过十二指肠。功能性空肠间置代胃术安全可靠,对于减少全胃切除术后并发症的发生率,提高生活质量和营养状况有着重要的意义。
Objective: After total gastrectomy often occur obvious malnutrition, a variety of postoperative adverse symptoms and quality of life decline. In this study, by comparing the four methods of gastrectomy after total gastrectomy, to investigate the ideal gastrectomy after total gastrectomy. Methods: A total of 196 patients with gastric cancer treated by total gastrectomy in our hospital from November 2007 to March 2011 were divided into two groups: group A (functional jejunal interposition of gastric bypass), group B Intercostal gastrostomy), C group (P Roux-en-Y jejunal on behalf of stomach surgery), D group (modified Longmire method jejunal on behalf of the stomach) 4 kinds of digestive tract reconstruction. The operation time, blood loss, hospitalization time and mortality rate, quality of life 1 year after operation, nutritional status and postoperative complications were compared between the 4 groups. Results: There was no significant difference in average operation time, bleeding volume, hospitalization time and mortality between the 4 groups (P> 0.05). The incidence of dumping syndrome, reflux esophagitis and Roux-en-Y retention syndrome in group A were 2.1% (1/48), 4.2% (2/48) and 2.1% (1/48) respectively, both Significantly lower than the other three groups (all P <0.05). The quality of life at 1 year after operation (Visick grading index) was significantly better in group A than in the other 3 groups (all P <0.05). The nutritional index (PNI) at 1 year after operation was 55.40 ± 3.6, 52.30 ± 2.8, 41.5 ± 4.3 and 40.7 ± 5.5, respectively. The A group and B group were significantly higher than those in C group and D group (P <0.05) There was no significant difference between group B and group C (P> 0.05). There was no significant difference between group C and group D (P> 0.05). CONCLUSIONS: Gastrointestinal reconstitution following total gastrectomy should maintain jejunal continuity and maintain food intake through the duodenum. Functional jejunal interpositional replacement of gastric surgery is safe and reliable, which is of great significance for reducing the incidence of complications after total gastrectomy, improving quality of life and nutritional status.