近端胃大部切除间置空肠代胃对近端胃癌术后胃肠功能及近期生存情况的影响  

Effect of Proximal Subtotal Gastrectomy and Jejunal Interposition Surgery on Gastrointestinal Function,Nutritional Status and Short-term Survival after proximal gastrectomy

作　　者：罗亮[1] 吴宸 陈进[1] 陈汇 彭方兴 LUO Liang;WU Chen;CHEN Jin(Sichuan Mianyang 404 Hospital,Mianyang 621000)

机构地区：[1]四川绵阳四〇四医院普外科,四川绵阳621000

出　　处：《医学临床研究》2020年第5期715-717,720,共4页Journal of Clinical Research

摘　　要：[目的]探讨近端胃大部切除间置空肠代胃对近端胃癌患者术后胃肠功能及近期生存情况的影响.[方法]回顾性分析2013年8月至2017年5月本院收治的105例近端胃癌患者的临床资料,根据治疗方法的不同分为对照组(根治性全胃切除+食管空肠Roux-en-Y吻合手术,n=43)和观察组(近端胃大部分切除间置空肠代胃手术,n=62).比较两组患者的围术期情况、术后并发症发生情况;比较两组患者胃肠功能,包括两组患者术前和术后3个月胃肠激素[胃泌素(GAS)、胃动素(M L T)]水平、术后排气时间;比较两组患者术后1年、2年生存率.[结果]观察组手术时间长于对照组,术中出血量、淋巴清扫数目低于对照组,差异有统计学意义(P<0.05);两组患者手术切口长度比较,差异无统计学意义(P>0.05).术后3个月,两组患者GAS、MLT水平均低于术前,观察组GAS水平高于对照组,差异有统计学意义(P<0.05);两组MLT水平及术后排气时间比较,差异无统计学意义(P>0.05).观察组患者倾倒综合征、Roux滞留综合征及反流性食管炎发生率均明显低于对照组,差异均有统计学意义(P<0.05).观察组术后1年、2年生存率分别为95.16%(59/62)、90.32%(56/62),对照组分别为90.70%(39/43)、83.72%(36/43),两组比较差异均无统计学意义(P>0.05).[结论]近端胃大部切除间置空肠代胃治疗近端胃癌临床疗效更显著,可降低患者术后倾倒综合征、Roux滞留综合征及反流性食管炎发生率,是一种较为理想的近端胃癌术后消化道重建方式.[Objective]To investigate the efect of proximal subtotal gastrectomy and jejunal interposition surgery on gastrointestinal function,nutritional status and short-term survival after proximal gastrectomy.[Methcds]The clinical da-ta of 105 patients with proximal gastric cancer treated surgically in our hospital from August 2013 to May 2017 were ret-rospectively analyzed.According to the different treatment methods,patients were divided into the control group(n=43)and the observation group(n=62).The patients in the control group were treated with radical total gastrectomy plus esophagojejunal Roux en-Y anastomosis.While patients in the observation group were treated with proximal subtotal gastrectomy and jejunal interposition surgery.The perioperative indicators and the incidence of complications were com-pared between the two groups.The gastrointestinal function was compared between the two groups as well,including the levels of gastrointestinal hormones(GAS and MLT),and the time of exhaust after operation.Nutritional status,1-year and 2-year survival rates were recorded between the two groups.[Results]The operation time of the observation group was significantly longer than that of the control group(P<0.05),while the amount of bleeding and lymphatic clearance were significeantly lower than those of the control group(P<0.05).There was no statistical difference in the length of in-cision between the two groups(P>0.05).Three months after operation,the levels of GAS and MTL in both groups were lower than those before operation,however,the level of GAS in the observation group was higher than that in the control group(P<0.05).There were no significant differences in the levels of MLT and the time of exhaust after opera-tion between the two groups(P>0.05).The incidence of dumping syndrome,Roux detention syndrome and reflux esophagitis in the observation group was significantly lower than that in the control group(P<0.05).There was no sig-nificant difference in incision infection,pulmonary infection,abdominal infection,an

关 键 词：胃肿瘤/外科学 胃肠活动 存活率 

分 类 号：R735.2[医药卫生—肿瘤]