腹腔镜全胃切除术不同消化道重建方法对患者术后胆囊功能及胆结石发生的对比研究  

Comparison of different reconstruction methods of alimentary canal after laparoscopic total gastrectomy on gallbladder function and occurrence of gallstones

作　　者：张俊飞[1] 宋新梅[2] 谢文杰[1] 杨茜[1] 牛帅 Zhang Junfei;Song Xinmei;Xie Wenjie;Yang Xi;Niu Shuai(Baoding First Central Hospital,Baoding Hebei Province 071000,China;Second Hospital of Baoding City,Baoding Hebei Province 071000,China)

机构地区：[1]保定市第一中心医院,河北保定071000 [2]保定市第二医院,河北保定071000

出　　处：《中华普外科手术学杂志（电子版）》2022年第2期192-195,共4页Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)

基　　金：河北省医学科学研究重点课题计划(20190287)。

摘　　要：目的探讨不同消化道重建在腹腔镜全胃切除术患者中的预后影响。方法回顾性选取2019年1月至2020年11月行全胃切除术治疗胃癌的76例患者临床资料,根据消化道重建方式的不同分为两组,双通道组40例行双通道空肠间置术,Roux-en-Y组36例行食管空肠Roux-en-Y吻合术。数据采用统计软件SPSS 22.0进行分析,围手术期指标、肠道菌群、胆囊收缩功能等计量资料用(-x±s)表示,组间比较独立样本t检验;术后并发症等计数资料组间比较采用χ^(2)检验,等级计数资料采用秩和检验;P<0.05为差异有统计学意义。结果所有患者均顺利完成手术,无中转开腹者。双通道组术后首次排气时间短于Roux-en-Y组(P<0.05);术后3、6个月肠道菌群及胆囊功能情况:双通道组双歧杆菌、乳酸杆菌较术前升高,肠球菌、大肠杆菌降低,且均优于Roux-en-Y组(P<0.05);Roux-en-Y组双歧杆菌、乳酸杆菌较术前降低,肠球菌、大肠杆菌升高(P<0.05);双通道组胆囊容积、血清胆囊收缩素(CCK)水平低于Roux-en-Y组,胆囊排空率高于Roux-en-Y组(P<0.05);Roux-en-Y组胆囊容积、CCK水平较术前升高,胆囊排空率降低(P<0.05)。双通道组胆囊结石发生率及并发症总发生率低于Roux-en-Y组(χ^(2)=3.985,P=0.046;χ^(2)=4.504,k00.034)。结论腹腔镜全胃切除术患者行双通道空肠间置术可有效促进其肠道功能恢复,维持肠道菌群平衡,有利于患者胆囊收缩功能恢复,减少胆囊结石的发生。Objective To investigate the effect of different digestive tract reconstruction in patients with laparoscopic total gastrectomy.Methods The clinical data of 76 patients who underwent total gastrectomy for gastric cancer from January 2019 to November 2020 were retrospectively selected,and divided into two groups according to the different reconstruction methods of digestive tract.40 patients in the double-channel jejunal interposition group and 36 patients in the Roux-en-Y esophagojejunal Roux-en-Y anastomosis group received double-channel jejunal interposition.Statistical software SPSS 22.0 was used for data analysis.Perioperative indicators,intestinal microflora,gallbladder contraction function and other measurement data were represented by(-x±s),and independent t test was performed between groups.Statistical data such as postoperative complications were compared byχ^(2) test and rank sum test.P<0.05 was statistically significant.Results All patients successfully completed the operation,and no patients were converted to open surgery.The first postoperative exhaust time in the two-channel group was shorter than that in the Roux-en-Y group(P<0.05).Here are the results of 3 and 6 months after surgery:Bifidobacteria and lactobacillus were increased in the two-channel group,enterococcus and Escherichia coli were decreased,while enterococcus and Escherichia coli were increased(P?0.05);In roux-en-Y group,bifidobacteria and lactobacillus were decreased,while enterococcus and Escherichia coli were increased(P?0.05);The gallbladder volume and serum cholecystokinin(CCK)in the two-channel group were lower than those in the ROUX-en-Y group,and the gallbladder emptation rate was higher than that in the RouX-en-Y group(P<0.05);The incidence of gallstones and complications in the dual-channel group was lower than that in the Roux-en-Y group(χ^(2)=3.985,P=0.046;χ^(2)=4.504,P=0.034).Conclusion Double channel jejunal interposition in laparoscopic total gastrectomy can effectively promote the recovery of intestinal function and

关 键 词：胃切除术 腹腔镜 双通道空肠间置术 肠道菌群 胆囊收缩功能 疗效比较研究 

分 类 号：R65[医药卫生—外科学]