不同消化道重建吻合方式对全胃切除术后胃癌患者的影响  

Effects of different digestive tract reconstruction and anastomotic methods on patients with gastric cancer after total gastrectomy

作　　者：刘园蔚 程楠 杨得振 贾勇 董明 汤鑫 杨小东 袁虎豹 LIU Yuan-wei;CHENG Nan;YANG De-zhen;JIA Yong;DONG Ming;TANG Xin;YANG Xiao-dong;YUAN Hu-bao(Department of Oncology,Shaanxi University of Traditional Chinese Medicine Affiliated Hospital,Xianyang 712046,China)

机构地区：[1]陕西中医药大学附属医院肿瘤外科,咸阳712046

出　　处：《中国肿瘤临床与康复》2022年第3期257-260,共4页Chinese Journal of Clinical Oncology and Rehabilitation

摘　　要：目的 探讨空肠鲁氏Y形吻合(Roux-en-y)与调节型双通道空肠间置消化道重建(a-DJI)消化道重建吻合方式对全胃切除术后胃癌患者胃肠功能和生活质量的影响。方法 选取2016年10月至2020年9月间陕西中医药大学附属医院收治的行全胃切除术的82例胃癌患者,采用随机数表法分为研究组和对照组,每组41例。研究组患者采用a-DJI进行消化道重建吻合,对照组患者采用Roux-en-y进行消化道重建吻合,比较两组患者术后胃肠功能恢复情况、术后并发症、手术前后机体营养指标及术后生活质量。结果 研究组患者首次排气时间、首次排便时间和肠鸣音频率均低于对照组,胃液引流量高于对照组,差异均有统计学意义(均P<0.05)。两组患者术后并发症总发生率比较,差异无统计学意义(P>0.05)。术前,两组患者总蛋白与血红蛋白水平比较,差异无统计学意义(P>0.05);术后6个月,研究组患者总蛋白和血红蛋白水平均高于对照组,差异均有统计学意义(均P<0.05)。术后1个月,两组患者生活质量各项评分比较,差异无统计学意义(P>0.05);术后6个月,研究组患者生活质量各项评分均高于对照组,差异均有统计学意义(均P<0.05)。结论 与Roux-en-y术式相比,采用a-DJI进行全胃切除术后消化道重建吻合,能有效促进胃癌患者术后胃肠功能恢复,保障营养状况与生活质量,值得临床推广。Objective To investigate the effects of Roux-en-Y anastomosis and accommodated double tract and jejunal interposition reconstruction(ADJI) on gastrointestinal function and quality of life in patients with gastric cancer after total gastrectomy. Methods Eighty-two patients with gastric cancer who underwent total gastrectomy were selected at Shaanxi University of Traditional Chinese Medicine Affiliated Hospital from October 2016 to September 2020. They were randomly divided into an experimental group and a control group with 41 patients in each group. The experimental group underwent total gastrectomy with accommodated double tract and jejunal interposition reconstruction and the control group underwent total gastrectomy with Roux-en-Y reconstruction. The recovery of gastrointestinal function, postoperative complications, nutritional indexes and quality of life were compared between the two groups. Results Time to postoperative exhaust and defecation and the frequency of bowel sounds were lower in the experimental group than in the control group(all P<0.05). The gastric juice drainage was higher in the experimental group in of the control group(P<0.05). There was no significant difference in the incidence of postoperative complications between the two groups(P>0.05). At 6 months after operation, the levels of total protein and hemoglobin were higher in the experimental group than in the control group(all P<0.05). There was no significant difference in quality of life scores between the two groups at 1 month after the operation(P>0.05). At 6 months after operation, the scores of quality of life were higher in the experimental group in the control group(all P<0.05). Conclusion Compared with Roux-en-Y, total gastrectomy with accommodated double tract and jejunal interposition reconstruction can effectively promote the recovery of gastrointestinal function and guarantee the nutritional status and quality of life in patients with gastric cancer. It is worthy of clinical promotion.

关 键 词：鲁氏Y形吻合 调节型双通道空肠间置消化道重建 全胃切除术 胃肿瘤 胃肠功能 

分 类 号：R735.2[医药卫生—肿瘤]