全胃切除术后两种消化道重建方式在老年胃癌患者中的临床疗效比较  

Comparison of clinical effects between two models of alimentary reconstruction after total gastrectomy in the elderly patients with gastric cancer

作　　者：余涛[1] 曹祥龙[1] 贾文焯[1] 赵刚[1] 吴国举[1] 肖刚[1] 黄美雄[1] 

机构地区：[1]北京医院国家老年医学中心普通外科,100730

出　　处：《中华老年医学杂志》2017年第3期300-302,共3页Chinese Journal of Geriatrics

摘　　要：目的比较全胃切除术后两种消化道重建方式在老年胃癌患者中的临床疗效。方法回顾性分析2007年1月至2012年12月因胃癌于北京医院行全胃切除术患者共70例。其中，接受Roux-en-Y空肠代胃吻合的40例；接受改良BrawnⅠ食管-空肠吻合的30例，对两组临床资料、手术安全性和术后生活质量进行分析。结果两组手术时间[（209．8±14．0）min和（218．5±30．7）min，t=-1．697，P〉0.05）]、出血量[（376±25）ml和（3924±43）m1），t=-1．956，P〉0．05]、术后并发症（17．5％和16．7％，χ^2=0．008，P〉0.05）比较差异无统计学意义；Roux-en-Y空肠代胃吻合组进流食时间[（4．8±2．1）d和（7．6±2．4）d，t=-5．192，P〈0．05]、进半流食时间[（9．5±3．6）d和（11．5±3．7）d，t=-2．273，P〈0．05]明显缩短；术后6个月两组体重、血红蛋白、总蛋白和白蛋白比较差异无统计学意义；Roux-en-Y空肠代胃吻合组Visik指数1～2级的患者比例高于改良BrawnⅠ组（86．7％和62．5％，χ^2=5．063，P〈0．05）。结论Roux-en-Y空肠代胃吻合是老年胃癌患者全胃切除术后的理想术式。Objective To investigate the comparison of clinical effects between two models of alimentary reconstruction after total gastrectomy in the elderly patients with gastric cancer. Methods 70 patients receiving alimentary tract reconstructions of Orr-type Roux-en-Y reconstruction （Orr- type, 40 cases） and modified Brawn I （30 cases） from January 2007 to December 2012 were retrospectively analyzed. The operative time, amount of bleeding, early postoperative complications and mortality, food intake, nutritional status and alimentary tract function were compared at 6 months after surgery. Results There were no significant differences between the two methods in the operative time [（198.8±14.0）min vs 233. 5 ±30. 7） min, t= - 1. 697, P〉0.05）], amount of bleeding [（420± 43） ml vs （340 ±25） m[ t = - 1.956, P〉0.05], and early postoperative complications [（17.5% vs 16.7% ）, χ^2= 0. 008,P〉0. 05]. However, times of liquid diet intake and semi liquid diet intake of the Orr-type reconstruction method was comparatively shorter than that of the modified Brawn Ⅰ[（4.8±2.1） dvs （7.6±2.4） d, and （9.5±3.6） d vs （11.5±3.7） d, t=- 5. 192, P〈0.05）]. Nutritional status （weight, hemoglobin, total serum proteins and serum albumin） at 6 months after operation showed no significant differences between the two methods. But constituent ratio of Visick scores Ⅰ-Ⅱ of Orr-type was bigger than that of modified Brawn Ⅰ （86.7% vs 62. 5%, 2 =5. 063,P〉0.05）. Conclusions Orr-type Roux-en-Y reconstruction method can avoid reflux esophagitis, and the procedure is more simple than the modified Brawn Ⅰ method. Therefore, Orr-type Roux-en-Y reconstruction should be recommended as an adoptable method of digestive reconstruction after total gastrectomy for gastric cancer in the elderly patients.

关 键 词：胃肿瘤 全胃切除 消化道重建 

分 类 号：R735.2[医药卫生—肿瘤]