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目的探讨全胃切除术的消化道重建方式方法。方法比较胃癌患者全胃切除术行P型空肠袢食管空肠Roux-en-Y吻合术(PRY,120例)和改良“P”型空肠间置代胃术(mPJIP,122例)2种不同消化道重建术式的临床疗效。观察并记录手术时间、手术并发症及营养指标的变化。结果 PRY组和mPJIP组手术时间分别为(3.8±0.2)h和(3.6±0.1)h(P>0.05);PRY组手术并发症和病死率[13例(10.8%),4例(3.3%)]明显高于mPJIP组[9例(7.4%),3例(2.5%)](均P<0.05);营养指标比较,mPJIP组在体质量改变、总蛋白改变、预后营养指数上显著优于PRY组(均P<0.05)。结论改良“P”型空肠间置代胃术(mPJIP)可提高患者的生活质量,降低全胃切除术后并发症的发生率及病死率,是全胃切除术较为理想的消化道重建方式,具有临床推广价值。
Objective To investigate the method of total gastrectomy for reconstruction of digestive tract. Methods Compared with Roux-en-Y anastomosis of P-type jejunum and esophageal-jejunal jejunum (PRY, 120 cases) and modified “P-type” jejunal interpositional replacement of stomach (mPJIP, 122 cases) Clinical efficacy of different digestive tract reconstruction. Observe and record the operation time, complications and nutrition changes. Results The operative time in PRY group and mPJIP group were (3.8 ± 0.2) h and (3.6 ± 0.1) h respectively (P> 0.05). The complications and mortality in PRY group were 13 cases (10.8%), 4 cases (3.3% ) Were significantly higher than those in the mPJIP group (n = 9 (7.4%), n = 3 (2.5%)] (all P <0.05). The mPJIP group was significantly better than the mPJIP group in terms of body weight, total protein, In PRY group (all P <0.05). Conclusion Improved “P” jejunal interposition gastric bypass (mPJIP) can improve the quality of life of patients, reduce the incidence of postoperative gastrectomy complications and mortality, gastrectomy is an ideal reconstruction of the digestive tract Way, with clinical promotion value.