全胃切除术后非离断式Roux-en-Y消化道重建术临床应用.docVIP

全胃切除术后非离断式Roux-en-Y消化道重建术临床应用 　 作者：石磊　陈平　赵伟　朱群山　宗亮　秦晓辉 【摘要】 目的：探讨全胃切除术后3种消化道重建方式的临床效果。方法：将106例胃癌患者按全胃切除后消化道重建方式不同分为非离断式Roux-en-Y吻合术38例（A组）、J型空肠储袋Roux-en-Y吻合术31例（B组）和Orr式空肠食管Roux-en-Y吻合术37例（C组）。比较各组患者消化道重建时间、术后并发症发生率、进食后症状、单餐进食量、体质量和相关营养代谢指标及胃排空情况。结果：消化道重建时间A组最短，与B组差异有统计学意义（P＜0.05）；碱性反流性食管炎发生率3组差异无统计学意义（Pgt;0.05），Roux潴留综合征发生率A组明显低于B、C组（P＜0.05）；Visick分级指数I～II级的患者比率，A组高于B、C组（P＜0.05）；术后6个月和12个月单餐进食量达到术前80%的患者比率，A、B组均明显高于C组（P＜0.05）；术后6个月3组体质量、血红蛋白、白蛋白下降程度及预后营养指数（PNI）差异无统计学意义（P＞0.05），术后12个月，除血红蛋白外，体质量和白蛋白下降程度A、B组较C组低（Plt;0.05），PNI A、B组较C组高（Plt;0.05）；术后1年A、B组胃半排空时间较C组明显延长（Plt;0.05）。结论：非离断式Roux-en-Y术是胃癌全胃切除术后消化道重建较为合适的术式。 【关键词】 胃肿瘤·全胃切除术·消化道重建·吻合术，Roux-en-Y·Roux潴留综合征 　　【ABSTRACT】 Objective: To investigate the efficacy of three different methods of digestive tract reconstruction after total gastrectomy．Methods: A total of 106 cases underwent the uncutted Roux-en-Y esophagojejunostomy with a jejunal pouch（group A, n=38）, Roux-en-Y esophagojejunostomy with the J-type jejunal pouch（group B，n=31）, and Roux-en-Y esophagojejunostomy with the Orr-type jejunal pouch （group C, n=37） respectively.The clinical data were retrospectively stud ied．The digestive tract reconstruction time, the post-operative complication incidence rate, postprandial symptoms, food-intake quantity, weight, serum nutritional parameters and emptying time of the gastricsubstitute were compared respectively. Results: The reconstruction time was the shortest in group A, which was significantly shorter than that in group B（P＜0.05）. There were no significant differences among 3 groups in the incidence of alkaline refluxgastritis（P＞0.05）, Group A was significantly lower than group B and C in the incidence of roux stasis syndrome. The Visick score of group A were superior to those of group B and C in 6 and 12 months after operation．The food intake gain of group A and B were superior to that of group C 6 and 12 months after operation. There were no significant differences among 3 groups in the term of weight, Hb and