全胃切除术后的消化道重建术式的比较  

Comparison of digestive tract reconstruction procedures following total gastrectomy

作　　者：丁佩剑[1] 杨阳[2] 丁双剑[3] 杨宗伟[4] 

机构地区：[1]承德医学院附属医院肿瘤外科,河北承德067000 [2]承德医学院附属医院骨外科,河北承德067000 [3]承德医学院附属医院肿瘤外二科,河北承德067000 [4]承德医学院附属医院胸外科,河北承德067000

出　　处：《中国普通外科杂志》2011年第9期975-978,共4页China Journal of General Surgery

摘　　要：目的探讨全胃切除术的消化道重建方式方法。方法比较胃癌患者全胃切除术行P型空肠袢食管空肠Roux-en-Y吻合术(PRY,120例)和改良"P"型空肠间置代胃术(mPJIP,122例)2种不同消化道重建术式的临床疗效。观察并记录手术时间、手术并发症及营养指标的变化。结果 PRY组和mPJIP组手术时间分别为(3.8±0.2)h和(3.6±0.1)h(P>0.05);PRY组手术并发症和病死率[13例(10.8%),4例(3.3%)]明显高于mPJIP组[9例(7.4%),3例(2.5%)](均P<0.05);营养指标比较,mPJIP组在体质量改变、总蛋白改变、预后营养指数上显著优于PRY组(均P<0.05)。结论改良"P"型空肠间置代胃术(mPJIP)可提高患者的生活质量,降低全胃切除术后并发症的发生率及病死率,是全胃切除术较为理想的消化道重建方式,具有临床推广价值。Objective To explore the digestive tract reconstruction procedure after total gastrectomy.Methods The clinical efficacies of two types of digestive tract reconstruction procedures,P-type jejunal pouch Roux-en-Y esophagojejunostomy（PRY,n=120） and modified ＂P＂ jejunal interposition pouch reconstruction（mPJIP,n=122）,were compared.The operative time,surgical complications and change of postoperative nutrition indexes were observed.Results There was no statistical difference（P0.05） in operation time between PRY and mPJIP group,which was（3.8±0.2） h and（3.6±0.1） h,respectively.The surgical complications and death of PRY group [13 cases（10.8%）,4 cases（3.3%）] were significantly higher than and those of mPJIP group [9 cases（7.4%）,3 cases（2.5%）]（both P0.05）.The postoperative nutrition indexes alteration such as body weight,total protein and prognostic nutritional index in mPJIP group were significantly better than those of PRY group（all P0.05）.Conclusions The mPJIP reconstruction can improve patient′s quality of life and reduce the postopertative complications and mortality of total gastrectomy.mPJIP is an ideal procedure for digestive tract reconstruction after total gastrectomy and therefore is recommended for use in clinical practice.

关 键 词：胃肿瘤/外科学 胃切除术/方法 空肠间置代胃术 食管空肠Roux-en-Y吻合术 全胃切除术 

分 类 号：R735.2[医药卫生—肿瘤]