全胃切除术行非离断式食管空肠Roux-en-Y吻合术与空肠ρ袢代胃术的临床分析  

The clinical analysis of Un-cut/ρ-looped jejunal pouch Roux-en-Y esophagojejunostomy in total gastrectomy

作　　者：何平[1] 梁杰雄[1] 邵天松[1] 宋辉[1] 张钊[1] 李洋[1] 

机构地区：[1]首都医科大学附属北京安贞医院普外科,北京100029

出　　处：《中华普外科手术学杂志（电子版）》2017年第1期23-26,共4页Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)

摘　　要：目的对非离断式食管空肠改良Roux-en-Y吻合术(URY)与空肠ρ袢代胃术对胃癌全胃切除(PRY)术后患者消化道重建的临床优势进行探讨分析,为临床全胃切除术后患者消化道重建方法的选择提供依据。方法选择2012年1月至2016年5月接受全胃切除术的62例胃癌患者作为观察对象,按数字表法分为URY组PRY组,每组31例。术后定期随访12个月,采用SPSS 22.0统计学软件进行数据统计,手术时间、住院时间、营养学指标等用均数±标准差(x珋±s)表示,运用t检验;术后并发症指标、生活质量指标及死亡例数以(%)表示,采用χ~2检验,P<0.05表示差异有统计学意义。结果 URY组患者的手术时间、住院时间、手术并发症及死亡例数等指标均显著优于PRY组,差异有统计学意义(t=3.728,P=0.003;t=4.002,P=0.002;χ~2=3.649,P=0.010;χ~2=4.334,P=0.001)。URY组患者术后3个月时的总蛋白变化与预后营养指数显著优于PRY组,且差异有统计学意义(t=3.886,P=0.011;t=3.922,P=0.002)。URY组术后12个月腹胀、倾倒综合征、反流性食管炎及Visick分级等指标等并发症的发生率显著低于PRY组,且差异有统计学意义(χ~2=2.952,P=0.032;χ~2=4.004,P=0.021;χ~2=3.441,P=0.014;χ~2=3.940,P=0.003)。URY组的总体生活质量评分在手术3个月和6个月后明显高于PRY组,差异具有统计学意义(t=3.802,P=0.030;t=4.036,P=0.012)。结论 URY手术对于全胃切除术后消化道重建具有快速、有效、并发症少及安全性好的疗效,具有较高的临床应用价值。Objective To explore the clinical advantages of the un-cut Roux-en-Y esophagojejunostomy compared with ρ-looped jejunal pouch Roux-en-Y esophagojejunostomy in patients undewent total gastrectomy, to provide the reference for the reconstruction of digestive tract after total gastrectomy. Methods From Jan 2012 to May 2016, 62 patients underwent total gastrectomy were enrolled in thi study, including the 31 cases in un-eut Roux-en-Y esophagojejunostomy group （URY group） and 31 cases in the p-looped jejunal pouch Roux-en-Y esophagojejunostomy group （PRY group）. Follow-up were performed within 12 months after surgery. Statistical analysis were performed by using SPSS 22. 0 software. Measurement data were expressed as mean ± standard deviation （x ± s）, and were examined by using t test, including operation time, hospital stay, nutrition indicators. Count data, such as postoperative complication rate, mortality, gastrointestinal complications after reconstruction indicators and quality of life indicators, were expressed as % , and were examined by usingχ2 test. A P value 〈0.05 was considered as statistically significant difference. Results In terms of operation time, length of hospital stay, complications and death eases in URY group were significantly better than those in PRY group respectively, with significant difference （ t = 3. 728, P = 0. 003 ; t = 4. 002, P = 0. 002; χ2 = 3. 649, P = 0. 010; χ2 =4. 334, P = 0. 001 ）. The change of total protein and the indicators of nutrition in URY group were significantly superior than those in PRY group, with significant difference （t = 3. 886, P = 0. 011;t = 3. 922, P = 0. 002 ）. The incidences of postoperative complications （ abdominal distention, dumping syndrome in December, reflux esophagitis and Visick grading） in URY group were significantly lower than those in PRY group, with significant difference （χ 2= 2. 952, P = 0. 032 ; χ2= 4. 004, P = 0. 021 ; χ2 = 3. 441, P = 0. 014 ; χ2 = 3. 940, P = 0. 003 ）. The score in URY group was s

关 键 词：胃肿瘤 胃切除术 吻合术  Roux-en-Y 

分 类 号：R735.2[医药卫生—肿瘤]