腹腔镜保留贲门的次全胃切除术不同消化道重建方式对比  

Comparative study of different digestive tract reconstruction methods in laparoscopic subtotal gastrectomy with cardiac preservation

作　　者：蒋星鑫 刘杲 曾莉蓉 樊斌 JIANG Xing-xin;LIU Gao;ZENG Li-rong;FAN Bin(Department of Anesthesiology,Enshi Tujia and Miao Autonomous Prefecture Central Hospital/Enshi Clinical College,Wuhan University,Enshi Hubei 445000,China;Department of Colorectal and Anal Surgery,Enshi Tujia and Miao Autonomous Prefecture Central Hospital/Enshi Clinical College,Wuhan University,Enshi Hubei 445000,China)

机构地区：[1]恩施土家族苗族自治州中心医院麻醉科/武汉大学恩施临床学院,湖北恩施445000 [2]恩施土家族苗族自治州中心医院结直肠肛门外科/武汉大学恩施临床学院,湖北恩施445000

出　　处：《局解手术学杂志》2022年第11期989-993,共5页Journal of Regional Anatomy and Operative Surgery

基　　金：湖北省卫生健康委2021-2022年度科研项目(WJ2021F091)。

摘　　要：目的对比分析腹腔镜保留贲门的次全胃切除术不同消化道重建方式的临床效果。方法选取本院收治的行腹腔镜保留贲门的次全胃切除术患者90例,采用随机数字表法将其分为3组,每组30例,分别采用Roux-en-Y吻合(RY组)、空肠间置(JI)吻合(JI组)、空肠间置J型储袋(JIJP)吻合(JIJP组)。比较3组患者围术期相关指标、胃肠激素水平、术后并发症及营养状况指标。结果3组患者手术时间、术中出血量、淋巴结清扫数目、消化道重建时间和术后住院时间比较,差异无统计学意义(P>0.05);而JI组、JIJP组患者术后首次排气时间和首次进食时间显著短于RY组(P<0.05)。术后3 d,3组患者胃动素(MOT)、胃泌素(GAS)、生长抑素(SS)水平较术前均显著降低(P<0.05),胆囊收缩素(CCK)水平较术前均显著升高(P<0.05),其中JI组和JIJP组MOT、GAS、SS水平显著高于RY组(P<0.05),CCK水平低于RY组(P<0.05)。3组患者术后早期并发症发生情况比较,差异无统计学意义(P>0.05);而JIJP组术后远期并发症总发生率显著低于RY组(P<0.05)。术后6个月,3组患者血清血红蛋白(HB)、总蛋白(TP)、白蛋白(Alb)、BMI水平较术前均显著降低(P<0.05),且JIJP组患者各营养指标水平均明显高于RY组、JI组(P<0.05)。结论腹腔镜保留贲门的次全胃切除术中采用JI吻合和JIJP吻合更有利于患者术后胃肠道功能恢复,且JIJP吻合不仅可有效降低术后远期并发症发生的风险,还更有利于患者术后营养恢复,其优势更为明显。Objective To compare and analyze the clinical effect of different digestive tract reconstruction methods in laparoscopic subtotal gastrectomy with cardiac preservation.Methods A total of 90 patients who underwent laparoscopic subtotal gastrectomy with cardiac preservation in our hospital were selected.These patients were divided into three groups according to the random number table method,with 30 patients in each group,and Roux-en-Y anastomosis(the RY group),jejunal interposition(JI)anastomosis(the JI group)and jejunal interposition J-pouch(JIJP)anastomosis(the JIJP group)were used respectively.The perioperative related indexes,gastrointestinal hormone level,postoperative complications and nutritional status of the three groups were compared.Results There was no significant difference in operation time,intraoperative bleeding volume,number of lymph node dissection,gastrointestinal reconstruction time and postoperative hospital stay among the three groups(P>0.05).The first exhaust time and first eating time after operation in the JI group and the JIJP group were significantly shorter than those in the RY group(P<0.05).Three days after operation,the levels of motilin(MOT),gastrin(GAS),somatostatin(SS)in the three groups were significantly lower than those before operation(P<0.05),and the level of cholecystokinin(CCK)was significantly higher than that before operation(P<0.05).The levels of MOT,GAS and SS in the JI group and the JIJP group were significantly higher than those in the RY group(P<0.05),and the level of CCK was lower than that in the RY group(P<0.05).There was no significant difference in early postoperative complications among the three groups(P>0.05);but the total incidence of long-term postoperative complications in the JIJP group was significantly lower than that in the RY group(P<0.05).Six months after operation,the levels of hemoglobin(HB),total protein(TP),albumin(Alb)and BMI in the three groups were significantly lower than those before operation(P<0.05),and these nutritional index levels in the

关 键 词：腹腔镜 次全胃切除术 消化道重建 

分 类 号：R753.2[医药卫生—皮肤病学与性病学]