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目的探讨不同消化道重建方式对胃癌病人全胃切除术后生活质量、营养状态的影响。方法将我院2004年3月～2005年12月收治的69例行全胃切除术的病人按消化道重建方式的不同分为食管空肠Roux-en-Y吻合术组(R组)、P形空肠食管Roux-en-Y吻合术组(PR组)及P形空肠间置代胃术组(PI组),并对各组术后的生活质量和营养学指标进行对照观察。结果R组反流性食管炎发生率高(20%),VisickⅠ、VisickⅡ级病人比例低于PR组和PI组(P<0.01)。术后1年,PI组进食量、体重、血红蛋白及血浆总蛋白下降程度均显著低于R组和PR组(P<0.01),预后营养指数则高于R组和PR组(P<0.01)。结论P形空肠间置代胃术是全胃切除后一种较为合理的消化道重建方式,能够改善病人术后的生活质量及营养状况。
Objective To explore the effect of different modes of gastrointestinal reconstruction on the quality of life and nutritional status of patients with gastric cancer after total gastrectomy. Methods 69 cases of total gastrectomy patients treated in our hospital from March 2004 to December 2005 were divided into the Roux-en-Y anastomosis group (R group), P-type Jejunal esophageal Roux-en-Y anastomosis group (PR group) and P-jejunal interpositional replacement gastrogavage group (PI group). The postoperative quality of life and nutrition indexes of each group were compared. Results The incidence of reflux esophagitis in group R was high (20%), while the ratio of Visick Ⅰ and Visick Ⅱ was lower than those in group PR and PI (P <0.01). At 1 year after operation, the food intake, body weight, hemoglobin and plasma total protein in PI group were significantly lower than those in R group and PR group (P <0.01), but the nutritional index of PI group was higher than those in R group and PR group (P <0.01) . Conclusion P-jejunal interpositional gastroscopy is a more reasonable method of gastrointestinal reconstruction after total gastrectomy, which can improve the postoperative quality of life and nutritional status.