不同消化道吻合方式对胃癌全胃切除术后患者胃肠功能的影响  

Effect of Different Gastrointestinal Anastomoses on Gastrointestinal Function Recovery in Patients with Gastric Cancer

作　　者：许夕霞[1] 王彦霞[1] 王玲玲[1] 李瑞利[1] 王敏[1] 吕景霞[1] 赵雪峰[1] 李勇[1] 

机构地区：[1]河北医科大学第四医院外三科,河北省石家庄市050011

出　　处：《中国全科医学》2014年第11期1314-1316,共3页Chinese General Practice

基　　金：国家自然科学基金资助项目(81072033);河北省卫生厅医学重点科研项目(20110494)

摘　　要：目的探讨不同消化道吻合方式对胃癌全胃切除术后患者胃肠功能的影响。方法选择2010—2012年河北医科大学第四医院外三科确诊为胃癌并行胃癌全胃切除术患者228例,根据消化道吻合方式分为食管-空肠吻合术组106例和改良空肠间置术组122例。记录两组患者胃液引流量,肠鸣音频率,术后排气、排便时间,住院时间及手术相关并发症发生情况。术后第5天对两组患者进行疲劳记分,评估疲劳程度;检测两组患者血清C反应蛋白(CRP)、白介素-2(IL-2)、白介素-6(IL-6)水平。结果食管-空肠吻合术组患者胃液引流量为(125±33)ml/d,少于改良空肠间置术组的(226±82)ml/d(P<0.05);肠鸣音频率为(5.3±2.1)次/min,大于改良空肠间置组术的(3.8±1.8)次/min(P<0.05);排气、排便时间为(69.2±19.3)h,短于改良空肠间置术组的(78.5±22.6)h(P<0.05);住院时间为(9.8±4.3)d,短于改良空肠间置术组的(12.7±5.3)d(P<0.05)。食管-空肠吻合术组并发症发生率为14.2%(15/106),改良空肠间置术组为17.2%(21/122),两组差异无统计学意义(χ2=0.400,P=0.530)。食管-空肠吻合术组疲劳记分为(6.4±2.9)分,低于改良空肠间置术组的(7.8±3.1)分(P<0.05)。食管-空肠吻合术组血清CRP、IL-6水平分别为(7.4±2.7)mg/L、(118.7±38.9)ng/L,均低于改良空肠间置术组的(9.6±3.8)mg/L、(153.3±58.1)ng/L(P<0.05);而两组血清IL-2水平间差异无统计学意义〔(146.7±63.1)、(158.6±46.3)ng/L,P>0.05〕。结论相对于行食管-空肠吻合术患者,行改良空肠间置术的患者术后胃肠功能恢复较慢,疲劳程度较重,免疫功能较差,应进行个体化治疗及护理。Objective To investigate the effect of different gastrointestinal anastomoses （GIA） on gastrointestinal function recovery in patients with gastric cancer （GC）. Methods From 2010 to 2012, 228 GC patients in Department of General Surgery, the Fourth Hospital of Hebei Medical University who had total gastrectomy （TG） were divided, according to GIA options, into groups A （given option of esophagus - jejunum anastomosis, n = 106）, B （given option of improved jejunal interposition, n = 122）. The gastric drainage, frequency of bowel sound （BS）, flatus and defecation time, hospital stay, surgery - related complications were recorded. On the 5 th day after operation, a fatigue score was performed to evaluate the degree of fatigue, and serum C-reactive protein （CRP） , interleukin - 2 （IL - 2）, interleukin - 6 （IL - 6） determined. Results The gastric drainage of group A was （125 ± 33） mV d, less than that of group B （226 ± 82） mll d （P 〈 o. 05）; frequency of BS was （5. 3 ± 2. 1） times/min, higher than that of group B （3. 8 ± 1. 8） times/min （P 〈 0. 05）; flatus and defecation time was （69. 2 ± 19. 3） h, shorter than that of group B （78. 5 ± 22.6） h （P 〈 0. 05）; hospital stay was （9. 8 ± 4. 3） d, shorter than that of group B （12. 7 ± 5. 3） d （P 〈 0. 05）. The complication incidence was 14.2% （15/106） in group A, 17. 2% （211 122） in group B, the difference was no significant different （x2=0.400, P =0. 530）. The fatigue score of group A was （6.4 ± 2. 9） points, lower than that of group B （7. 8 ± 3. 1） points （P 〈 0. 05）. The levels of CRP, IL - 6 were （7.4 ± 2. 7） mg/L, （118.7 ± 38.9） ngiL in group A, lower than those in group B [ （9.6 ± 3.8） mg/L, （153.3 ± 58. 1） ng/L, P 〈 0.05]; there was no significant difference in IL - 2 between 2 groups [ （146.7 ± 63. 1） ng/L, （158.6 ± 46.3） ng/L, P〉 0. 05 ]. Conclusion As compared with patients who had esophagus - jejunum anastom

关 键 词：胃肿瘤 吻合术 外科 胃肠吻合术 

分 类 号：R473.6[医药卫生—护理学] R735.2[医药卫生—临床医学]