远端胃大部分切除术后消化道重建术式的对比研究  

Comparison of different surgical modalities for alimentary reconstruction after subtotal gastrectomy

作　　者：何琦文[1] 叶再元[2] 徐继[2] 胡浩威[1] 邵钦树[2] 张勤[2] 孙元水[2] 

机构地区：[1]浙江中医药大学第二临床医学院,杭州310053 [2]浙江省人民医院胃肠外科

出　　处：《浙江医学》2015年第3期222-225,共4页Zhejiang Medical Journal

基　　金：浙江省科技计划项目(2011C33009)

摘　　要：目的对比远端胃大部分切除术后行连续性空肠间置术与Billroth I式及Roux-en-Y式吻合术的临床效果。方法回顾性分析2012年1月至2013年6月接受手术的远端胃癌患者95例,按不同消化道重建方式分为3组。A组30例患者行连续性空肠间置术,B组32例行Billroth I式吻合术,C组33例行Roux-en-Y式吻合术。比较3组患者术前预后营养指数(PNI)、手术时间、术后6个月及1年并发症发生率、进食量、血浆白蛋白水平、体重及Visick分级指数。结果3组患者术前PNI均无统计学差异(均P>0.05)。A组患者手术时间与B组无明显差异,且均明显少于C组的手术时间(均P<0.05)。术后6个月及术后1年3组患者的进食量、体重及营养状况的恢复均无统计学差异(均P>0.05)。A组患者术后腹胀情况明显少于C组(P<0.05),胆汁反流性胃炎明显少于B组(P<0.05)。结论胃大部分切除术后连续性空肠间置,安全有效,与传统的Billroth I式及Roux-en-Y式吻合术比较,可缩短手术时间,更快的恢复患者的消化功能,维持消化道正常通路,防止胆汁反流,将有可能成为消化道重建的主要方式之一。Objective To compare the clinical efficacy of different surgical modalities for reconstruction of digestive canal after subtotal gastrectomy. Methods Ninety five patients with gastric cancer underwent subtotal gastrectomy with different surgical modalities for digestive reconstruction：30 patients with continual jejuna interposition （group A）, 32 with Bil rothⅠanastomo-sis （group B） and 33 patients with Roux- en- Y anastomosis. The symptom in alimentary canal, visick ranking index, plasma albumin, food- intake and body weight were compared among groups and gastric stump and stoma were inspected by gastroscope in 6 months and 1 year after surgery. Results The PNI showed no significant difference among three groups before operation. There were no significant differences in plasma albumin, food- intake and body weight among 3 groups 6 months and 1 year after surgery. The abdominal distension in group A was less than that in group C, the bile reflux gastritis in group A was less than that in group B. Conclusion Continual jejunal interposition is a safe and effective procedure. Compared with Bil rothⅠanastomosis and Roux- en- Y anastomosis, it can shorten the operation time, keep physiological continuity of digestive canal, avoid bile regurgitation and better restore of digestive function for patients undergoing subtotal gastrectomy.

关 键 词：胃癌 消化道重建 连续性空肠间置术 远端胃大部切除术 

分 类 号：R735.2[医药卫生—肿瘤]