全胃切除后消化道重建的前瞻性随机对照研究  

A prospective randomized study on the method of reconstruction after total gastrectomy

作　　者：卢辉山[1] 张建中[1] 吴心愿[1] 黄昌明[1] 王川[1] 张祥福[1] 

机构地区：[1]福建医科大学附属协和医院肿瘤科,福州350001

出　　处：《中华肿瘤杂志》2003年第3期255-257,共3页Chinese Journal of Oncology

基　　金：福建省卫生厅基金资助项目 ( 970 2 )

摘　　要：目的　探讨全胃切除术后消化道重建的合理术式。方法　以 12例健康人为对照 ,对12 0例胃癌行全胃切除后 ,随机按食管空肠Roux y吻合 (A组 )、食管空肠“P”袢 +Roux y吻合 (B组 )、食管空肠Hunt Lawrence吻合 (C组 )及食管空肠原位间置代胃术 (D组 )等 4种术式行消化道重建 ,并比较其术后生活质量、预后营养指标 (PNI)指数、体重、血液营养学指标、胃肠激素水平、免疫功能 ,并以此判断各术式的优劣。结果　D组在PNI指数、体重变化和血液营养学指标上均优于A、B、C组(P <0 .0 5 ) ;D组餐后 30min胆囊收缩素 (CCK)水平及NK细胞、CD4 细胞、CD8细胞以及CD4 CD8值与对照组相似 ,亦均优于A、B、C组 (P <0 .0 5 ) ,差异有具著性。结论　食管空肠原位间置代胃术是一较合理的消化道重建术式。其空肠“P”字型构造具有代胃的功能 ;食糜通过十二指肠刺激CCK等胃肠激素的分泌 ,有利于消化及营养的吸收 ;仅切断一端空肠以及适度大小的代胃 ,保持了空肠及系膜原来的连系 ,既简化了手术 ,又保证了间置代胃空肠的血运 ,吻合口无缺血坏死之忧。Objective To find an ideal reconstruction method after total gastrectomy. Methods With 12 healthy persons as control, a total of 120 gastric cancer patients received their digestive tract reconstruction after total gastrectomy were randomized into Roux en y esophagojejunostomy group (A), P pouch with Roux en y esophagojejunostomy group (B), Hunt Lawrence esophagojejunostomy group (C), and jejunal interposition esophagojejunostomy group (D). After operation, quality of life, prognosis nutrition index (PNI), body weight, serum nutritional parameters, gastrointestinal hormone level and immunal state were evaluated. Results The quality of life, PNI, body weight and serum nutritional parameters (SI, TS and Hb) were better in group D than those in groups A?B and C ( P <0.05). The cholecystokinin (CCK) level and NK cell, CD 4 + cell, CD 8 + cell and CD 4/CD 8 ratio in group D, being similar to the control group, were singnificantly higher than groups A?B and C ( P <0.05). Conclusion Modified jejunal interposition esophagojejunostomy is a reasonable reconstruction method . The construction of 'P' pouch, reserving foods as the stomach, can preserve the duodenal passage and secretion of the gastrointestinal hormones, which results in better digestion of the food and absorption of the nutrients. This method simplifies the operation and guarantee the blood supply of interpositioned jejunum without causing ischemia at the anastomotic orifice. [

关 键 词：全胃切除术 消化道重建 手术方式 胃癌 血液检查 营养学指标 

分 类 号：R735.2[医药卫生—肿瘤] R730.56[医药卫生—临床医学]