双通道吻合消化道重建术对腹腔镜下近端胃切除术患者营养状态和并发症的影响  

Effects of double tract reconstruction on nutritional status and complications in patients undergoing laparoscopic proximal gastrectomy

作　　者：施佩姝 罗德胜 叶珠霞 SHI Peishu;LUO Desheng;YE Zhuxia(Department of Gastrointestinal Surgery,Lishui Central Hospital,Zhejiang Province,Lishui 323000,China)

机构地区：[1]浙江省丽水市中心医院胃肠外科,浙江丽水323000

出　　处：《中国医药导报》2024年第13期67-69,86,共4页China Medical Herald

基　　金：浙江省医药卫生科技计划项目(2022KY1429)。

摘　　要：目的 探究双通道吻合消化道重建术(DTR)对腹腔镜下近端胃切除术(LPG)患者营养状态和并发症的影响。方法 选择2021年1月至2022年12月于浙江省丽水市中心医院收治的64例近端胃癌患者,依据手术方式将其分为对照组(32例)和试验组(32例)。对照组进行腹腔镜全胃切除空肠食管Roux-en-Y吻合消化道重建术,试验组进行LPG+DTR。评估两组围手术期指标[手术时间、术中出血量(IBV)、术后肛门首次排气时间、首次进食时间、术后视觉模拟评分法(VAS)评分、食管下括约肌压力(LESP)];比较两组术前及术后3 d胃肠激素水平[胃动素(MTL)、生长抑素(SST)、血管活性肠肽(VIP)];比较两组术前及术后3个月营养指标[血红蛋白(Hb)、血清白蛋白(Alb)、体重指数(BMI)],观察术后并发症。结果 试验组手术时间、首次进食时间长于对照组,术后肛门首次排气时间短于对照组,IBV、VAS低于对照组,LESP高于对照组(P<0.05)。术后3 d,两组的MTL和SST均低于术前,VIP高于术前,且试验组MTL、SST高于对照组,VIP低于对照组(P<0.05)。术后3个月,两组的Hb、Alb低于术前,对照组BMI低于本组术前,试验组BMI高于本组术前,且试验组Hb、Alb、BMI高于对照组(P<0.05)。试验组术后并发症总发生率低于对照组(P<0.05)。结论 DTR联合LPG治疗近端胃癌患者,可改善其营养状态,调节胃肠激素水平,且能减少并发症。Objective To investigate the effects of double tract reconstruction(DTR) on nutritional status and complications in patients undergoing laparoscopic proximal gastrectomy(LPG).Methods Sixty-four patients with proximal gastric cancer admitted to Lishui Central Hospital,Zhejiang Province from January 2021 to December 2022 were selected and divided into control group(32 cases) and experimental group(32 cases) according to operative methods.The control group underwent laparoscopic total gastrectomy and reconstruction with Roux-en-Y jejunoesophagus anastomosis with digestive tract reconstruction,and the experimental group underwent LPG+DTR.Perioperative period indexes(operation time,intraoperative bleeding volume [IBV],first postoperative anal exhaust time,first feeding time,postoperative visual analogue scale [VAS] score,lower esophageal sphincter pressure [LESP]) were evaluated in both groups.The levels of gastrointestinal hormones(motilin [MTL],somatostatin [SST],vasoactive intestinal peptide [VIP]) before and three days after operation were compared between the two groups.Nutritional indexes(hemoglobin [Hb],serum albumin [Alb],and body mass index [BMI]) of the two groups were compared before and three months after operation,and postoperative complications were observed.Results The operation time and first feeding time of experimental group were longer than those of control group,the first postoperative anal exhaust time was shorter than that of control group,the IBV and VAS were lower than those of control group,and the LESP was higher than that of control group(P<0.05).At three days after surgery,MTL and SST in both groups were lower than those before operation,VIP was higher than that before operation,and MTL and SST in experimental group were higher than those of control group,VIP was lower than that of control group(P<0.05).Three months after operation,Hb and Alb of the two groups were lower than those before operation,BMI of the control group was lower than that before operation,BMI of the experimental group w

关 键 词：双通道吻合消化道重建术 腹腔镜下近端胃切除术 营养状态 并发症 

分 类 号：R735.2[医药卫生—肿瘤]