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目的探讨全胃切除术后不同食管空肠Roux-en-Y吻合方式的优劣及对患者术后生活质量的影响。方法对2001年1月～2006年12月该院施行全胃切除术的67例患者的临床资料进行回顾性分析。全胃切除后消化道重建分别采用常规端侧食管空肠Roux-en-Y吻合术(19例),P型空肠襻食管空肠Roux-en-Y吻合术(21例)和空肠贮袋食管空肠Roux-en-Y吻合术(27例)。记录患者一般情况及术后3个月、12个月的营养状况和胃肠道症状(GSPS)评分等。结果术后3个月、12个月P型空肠襻组与常规端侧食管空肠组比较,术后进食量明显增加(P<0.05),而GSPS评分明显降低(P<0.05)。空肠贮袋组术后3个月、12个月进食量同样优于常规端侧食管空肠组(P<0.05),GSPS评分明显降低(P<0.05)。术后12个月P型空肠襻组与空肠贮袋组体重恢复较常规端侧食管空肠组更佳(P<0.05),而术后12个月空肠贮袋组的患者进食量又优于P型空肠襻组,两组体重恢复相比,差异有统计学意义(P<0.05)。结论P型空肠襻和空肠贮袋食管空肠Roux-en-Y吻合术有利于维持患者术后生活质量,在每天进食量及体重恢复方面空肠贮袋更优于P型空肠襻。
Objective To investigate the advantages and disadvantages of Roux-en-Y anastomosis of different esophagus after total gastrectomy and the influence on postoperative quality of life. Methods The clinical data of 67 patients undergoing total gastrectomy in our hospital from January 2001 to December 2006 were analyzed retrospectively. Total gastrectomy and digestive tract reconstruction were performed with conventional endoscopic Roux-en-Y anastomosis (n = 19), Roux-en-Y anastomosis (n = 21) and jejunal Roux -en-Y anastomosis (27 cases). The general condition of patients and the nutritional status and gastrointestinal symptoms (GSPS) score at 3 months and 12 months after surgery were recorded. Results Compared with the conventional esophageal jejunum group, the postoperative food intake increased significantly (P <0.05) and the GSPS score decreased significantly at 3 months and 12 months postoperatively (P <0.05). After 3 months and 12 months, the food intake of jejunum storage group was also better than that of conventional esophageal jejunum group (P <0.05). GSPS score was significantly lower (P <0.05). At 12 months after operation, the body weight of P jejunum group and jejunum storage group were better than those of conventional esophageal jejunum group (P <0.05), but the food intake of jejunum pouch group after 12 months was better than P Type jejunum group, body weight recovery compared to the two groups, the difference was statistically significant (P <0.05). Conclusions Roux-en-Y anastomosis of P-type jejunum and esophageal jejunum is conducive to maintaining postoperative quality of life. Jejunal pouch is superior to P-type jejunum in daily intake and weight recovery.