Roux-en-Y式胃癌根治术联合胃旁路手术治疗进展期胃癌的疗效及对患者肠道屏障功能和并发症的影响  

Curative effect of Roux-en-Y type radical gastrectomy combined with gastric bypass in the treatment of advanced gastric cancer and the influence on intestinal barrier function and complications

作　　者：马银华 刘培根[1] 申梅英[1] 王萍[1] 徐成飞[2] MA Yin-hua;LIU Pei-gen;SHEN Mei-ying(Department of General Surgery,Panzhihua Central Hospital,Panzhihua Sichuan 617067,China)

机构地区：[1]攀枝花市中心医院普外科,四川攀枝花617067 [2]成都医学院第一附属医院胃肠外科,四川成都610000

出　　处：《临床和实验医学杂志》2022年第22期2407-2411,共5页Journal of Clinical and Experimental Medicine

基　　金：攀枝花学院教育教学研究与改革项目(编号:JJ2221)。

摘　　要：目的分析Roux-en-Y式胃癌根治术联合胃旁路手术治疗进展期胃癌的疗效及对患者肠道屏障功能及并发症的影响。方法回顾性研究,选取2016年8月至2019年1月攀枝花市中心医院收治的进展期胃癌80例患者,按手术方式将其分为Roux-en-Y式胃癌根治术组(传统组,n=38)、Roux-en-Y式胃癌根治术联合胃旁路手术组(联合组,n=42)。统计两组手术时间、术中出血量、肛门排气时间、拔管时间、下床活动时间、住院时间,比较两组手术前后肠道屏障功能指标[血二胺氧化酶(DAO)、内毒素脂多糖(LPS)、肿瘤坏死因子-α(TNF-α)、尿乳果糖/甘露醇(L/M)比值]的变化,记录患者随访6个月进食量、进食次数、体重、血红蛋白、白蛋白等营养指标及胃肠道症状(GSPS)评分的变化,统计手术并发症发生率。结果两组手术时间、术中出血量、下床活动时间、拔管时间、住院时间等资料比较,差异均无统计学意义(P>0.05)。术后12 d,两组DAO、LPS、L/M上升,TNF-α降低,联合组术后12 d LPS、TNF-α、L/M为(0.86±0.26)EU/mL、(5.13±2.93)mg/L、(0.06±0.01),均低于传统组[(1.36±0.34)EU/mL、(7.12±2.69)mg/L、(0.08±0.03)],差异均有统计学意义(P<0.05)。术后6个月,两组进食次数减少、血红蛋白上升、白蛋白及GSPS评分降低,联合组血红蛋白为(118.01±16.85)g/L,高于传统组[(108.67±15.26)g/L],GSPS评分为(3.39±0.27)分,低于传统组[(5.41±0.52)分],差异均有统计学意义(P<0.05)。两组手术近远期并发症发生率比较,差异无统计学意义(P>0.05)。结论Roux-en-Y式胃癌根治术联合胃旁路手术治疗进展期胃癌疗效肯定,存在肠道屏障功能保护效应,可改善患者术后营养状态,不会增加手术并发症发生风险,临床应用可行性强。Objective To analyze the curative effect of Roux-en-Y type radical gastrectomy combined with gastric bypass in the treatment of advanced gastric cancer and the influence on intestinal barrier function and complications.Methods A retrospective study was conducted.A total of 80 patients with advanced gastric cancer admitted to Panzhihua Central Hospital from August 2016 to January 2019 were selected and divided into Roux-en-Y type radical gastrectomy group(traditional group,n=38)and Roux-en-Y type radical gastrectomy combined with gastric bypass group(combined group,n=42).The operation time,intraoperative blood loss,anal exhaust time,extubation time,time to get out of bed and length of hospital stay were statistically analyzed.The changes of intestinal barrier function indexes[blood diamine oxidase(DAO),endotoxin lipopolysaccharide(LPS),tumor necrosis factor-α(TNF-α),urine lactulose/mannitol(L/M)ratio]before and after operation were compared between the two groups.The monthly food-intake,eating frequency,weight,hemoglobin,albumin and other nutritional indicators and changes in scores of gastrointestinal symptoms(GSPS)during 6 months of follow-up were recorded.The incidence of surgical complications was statistically analyzed.Results There was no significant difference in the operation time,intraoperative blood loss,time to get out of bed,extubation time or length of hospital stay between the two groups(P>0.05).The levels of DAO,LPS and L/M in the traditional group increased,while TNF-αdecreased at 12 d after operation,the levels of LPS,TNF-αand L/M in the combined group were(0.86±0.26)EU/mL,(5.13±2.93)mg/L,(0.06±0.01),which were lower than in the traditional group[(1.36±0.34)EU/mL,(7.12±2.69)mg/L,(0.08±0.03)]at 12 d after operation,the differences were statistically significant(P<0.05).The eating frequencies of both groups decreased,hemoglobin increased,albuminand GSPS scores decreased at 6 months after operation.Hemoglobin in the combined group was(118.01±16.85)g/L,which was higher than that in the trad

关 键 词：进展期胃癌 胃癌根治术 消化道重建 胃旁路手术 肠屏障 并发症 

分 类 号：R735.2[医药卫生—肿瘤]