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目的探讨全胃切除术后合理的消化道重建方式。方法自2006年1月—2008年7月,对44例全胃切除术分别采用Schlatter式及食管空肠Roux-en-Y式2种不同的消化道重建方式,对术中消化道重建时间,术后6个月患者自述症状,术后6个月患者并发症,术后6个月和24个月患者饮食情况、消化道症状和营养指标进行对比观察。结果 2种术式术中消化道重建时间差异无统计学意义(P>0.05)。术后6个月,Schlatter式术组患者返流性食管炎和营养不良的发生率明显高于食管空肠Roux-en-Y术组(P<0.05)。术后6个月患者自述术后症状,Schlatter式术组患者评分明显较Roux-en-Y组患者高(P<0.05)。术后6个月,2组患者体重增加、血红蛋白、血清总蛋白和血清白蛋白指标比较差异无显著性(P>0.05),但在术后24个月,空肠Roux-en-Y术组患者的上述指标有明显提高(P<0.05)。结论全胃切除术后采用食管空肠Roux-en-Y术,操作简单易行,能有效地防止反流性食管炎的发生,提高患者生活质量,可推荐为胃癌全胃切除后消化道重建的首选术式。
Objective To investigate the reasonable method of digestive tract reconstruction after total gastrectomy. Methods From January 2006 to July 2008, 44 cases of total gastrectomy were treated with Schlatter and Esophageal and Roux-en-Y two kinds of different digestive reconstruction methods respectively. The time, intraoperative gastrointestinal reconstruction time After 6 months, patients’ self-reported symptoms, complications at 6 months after operation, diet status, gastrointestinal symptoms and nutrition indexes at 6 months and 24 months after operation were compared. Results There was no significant difference in digestive tract reconstruction time between the two surgical procedures (P> 0.05). At 6 months, the incidence of reflux esophagitis and malnutrition was significantly higher in the Schlatter group than in the Roux-en-Y group (P <0.05). At 6 months postoperatively, the patient’s self-reported postoperative symptoms were significantly higher in the Schlatter-operated patients than in the Roux-en-Y patients (P <0.05). At 6 months after operation, there was no significant difference in body weight, hemoglobin, total serum protein and serum albumin between the two groups (P> 0.05), but in the jejunum Roux-en-Y group Of the above indicators were significantly increased (P <0.05). Conclusion Roux-en-Y esophagus and jejunum after total gastrectomy are simple and easy to operate, which can effectively prevent the occurrence of reflux esophagitis and improve the quality of life of patients. It can be recommended as gastrointestinal reconstruction after gastrectomy Preferred surgery.