胃癌根治性全胃切除术后两种消化道重建方式对患者生活质量及免疫营养状况的影响  

Effects of two different reconstruction methods of digestive tract after radical total gastrectomy on quality of life and immune nutrition status in patients with gastric cancer

作　　者：何天柱 胡抢 张璐 孙元水[2] He Tianzhu;Hu Qiang;Zhang Lu;Sun Yuanshui(The Second School of Medicine,Zhejiang Chinese Medical University,Hangzhou 310053,China)

机构地区：[1]浙江省立同德医院胃肠外科,杭州310053 [2]浙江省立同德医院胃肠外科,杭州310012

出　　处：《中华临床营养杂志》2019年第3期167-172,共6页Chinese Journal of Clinical Nutrition

基　　金：浙江省科技计划项目(2017F30045);浙江省中医药科技计划项目(2018ZZ004).

摘　　要：目的比较胃癌根治术后采用Roux-en-Y吻合术以及非离断式Roux-en-Y吻合术进行消化道重建的胃癌患者的生活质量、营养状况及免疫功能。方法选取2015年5月至2017年6月于我院行根治性全胃切除术的胃癌患者86例,根据消化道重建方式的不同分为URY组(非离断组,41例)和RY组(传统组,45例),比较两组患者术后1个月、3个月、6个月的生活质量及术前、术后1个月、术后3个月、术后6个月的白蛋白、前白蛋白、转铁蛋白、血红蛋白、视黄醇结合蛋白及体重等营养状况指标,以及CD4^+淋巴细胞、CD8^+淋巴细胞、CD4^+/CD8^+比例、IgG、IgM和IgA等免疫相关指标。结果对于生活质量的比较,在饮食受限方面,术后1个月,URY组的评分明显低于RY组(P<0.05),术后3个月及术后6个月时差异不明显(P>0.05);在焦虑方面,URY组在术后第1个月高于RY组(P<0.05),术后3个月、术后6个月低于RY组(P<0.05);在口干方面,URY组在术后3个月和术后6个月高于RY组(P<0.05),其余指标均无统计学差异(P>0.05)。对于营养指标的比较,术后6个月URY组在前白蛋白指标上高于RY组(P<0.05),其余均无统计学差异(P>0.05)。对于免疫指标的比较,两组均无统计学差异(P>0.05)。URY组术后住院时间少于RY组(P<0.05),且术后轻度反流症状发生率低于RY组(P<0.05),其余并发症发生率无统计学差异(P>0.05)。结论本研究除了在术后住院时间和术后并发症方面非离断式Roux-en-Y吻合术优于Roux-en-Y吻合术,两种消化道重建方式未发现明显的生活质量及营养免疫指标方面的优劣。Objective To compare the quality of life, nutritional status and immune function of gastric cancer patients with digestive tract reconstruction using Roux-en-Y anastomosis and uncut Roux-en-Y anastomosis after radical gastrectomy. Methods 86 patients with gastric cancer were selected from May 2015 to June 2017 with radical total gastrectomy. According to the different ways of the reconstruction of the digestive tract, the patients were divided into URY group ( non-severed group, 41 patients) and RY group (traditional group, 45 patients). The quality of life of the two groups was compared at 1 month, 3 months and 6 months after operation. The nutritional status of albumin, prealbumin, transferrin, hemoglobin, retinol binding protein and weight, as well as CD4^+ lymphocyte, CD8^+ lymphocyte, CD4^+/ CD8^+ ratio, IgG, IgM, IgA and other immune related indexes were observed at pre-operation and 1 month, 3 months and 6 months after oper-ation. Results As for quality of life, the score of diet limitation in group URY was significantly lower than that in group RY at 1 month after operation (P<0.05), and no significant difference at 3 months and 6 months after operation ( P〉0.05);As for anxiety, the score of group URY was higher than that in group RY ( P< 0.05 ) at 1 month after operation ( P<0.05), and was lower than that in group RY at 3 months and 6 months after operation ( P<0.05). As for dry mouth, group URY was higher than that in group RY (P<0.05) at 3 months and 6 months after operation ( P<0.05), and the other indexes were not statistically significant ( P> 0.05 ). As for the nutritional indexes, prealbumin in the URY group was higher than that in the RY group at 6 months after operation ( P<0.05 ), and the rest were not statistically significant ( P>0.05 ). There was no statistical significance in immune indexes between the two groups ( P > 0.05 ). The postoperative hospitalization time of URY group was less than that of RY group ( P<0.05), and the incidence of mild reflux symptoms was lower than that of RY gr

关 键 词：胃癌 消化道重建 生活质量 营养 免疫 

分 类 号：R735.2[医药卫生—肿瘤]