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目的:探讨全胃切除横结肠代胃术在胃癌治疗中的应用价值。方法:193例胃癌患者随机分为对照组与观察组,对照组采用传统食管/空肠Schlatter吻合术或食管/空肠Roux-en-Y吻合术重建消化道,观察组以横结肠代胃术重建消化道。比较两组术前、术后第1,9天T细胞亚群和IL-2及急性炎症介质的变化、术后病死率、并发症发生率、住院时间。结果:术前及术后第1天,两组各项指标差异均无统计学意义(均P>0.05);术后第9天,与对照组比较,观察组CD4+细胞比例,CD4+/CD8+,IL-2水平明显升高,而CD8+T细胞比例,IL-6,C-反应蛋白(CRP)水平明显降低(均P<0.05);两组术后病死率、并发症发生率差异无统计学意义(P>0.05),而观察组平均住院时间明显少于对照组(P<0.05)。结论:横结肠代胃术是一种安全的消化道重建新术式,对改善胃癌患者术后的免疫功能具有积极意义。
Objective: To investigate the value of total gastrectomy and transabdominal gastrectomy in the treatment of gastric cancer. Methods: A total of 193 patients with gastric cancer were randomly divided into control group and observation group. The control group received conventional esophageal / jejunal Schlatter anastomosis or esophageal / jejunal Roux-en-Y anastomosis to reconstruct the digestive tract. The observation group received transgasteral transgastric reconstruction of digestive tract . The changes of T cell subsets, IL-2 and acute inflammatory mediators on the first and ninth days after operation were compared between the two groups. The postoperative mortality, the incidence of complications and the length of stay were compared. Results: On the first day after operation, there was no significant difference between the two groups (all P> 0.05). On the 9th day after operation, the percentage of CD4 + cells, the ratio of CD4 + / CD8 + IL-2 levels were significantly increased, while the proportion of CD8 + T cells, IL-6 and C-reactive protein (CRP) levels were significantly lower (both P <0.05); there was no statistical difference in postoperative mortality and complications between the two groups (P> 0.05), while the average length of stay in the observation group was significantly less than that in the control group (P <0.05). Conclusion: The transabdominal transgastric gastroscopy is a safe new technique for reconstructing the digestive tract. It is of great significance to improve the immune function of gastric cancer patients after operation.