作者：王琳，黄灿坡，林建泉

单位：中国人民解放军联勤保障部队第910医院 普外科，福建 泉州362000

Authors: WANG Lin, HUANG Canpo, LIN Jianquan

Unit:  Department of General Surgery, the 910th Hospital of the People's Liberation Army Joint Service Support Force Fujian, Quanzhou 362000, Fujian, China

摘要：

目的  研究近端胃大部分切除间置空肠代胃手术对胃癌术后并发症及胃肠功能和营养状况的影响。方法  纳入2015年1月至2019年1月于我院收治的118例胃癌患者为对象,开展前瞻性研究。按抽签随机方法分为两组,各59例,其中对照组行全胃切除术+食管空肠Roux-en-Y吻合术,观察组实施近端胃大部分切除术+间置空肠代胃术。对比两组手术时间、术中出血量、淋巴结清扫总数、代胃肠管最大直径、代胃肠管内钡剂滞留时间、术后肛门排气时间、术后开始进食时间、术后住院时间,分析两组术后并发症发生情况,并比较两组手术前后血清胃泌素、胆囊收缩素、生长抑素、胃动素水平及血清白蛋白、总蛋白、血红蛋白、预后营养指数。结果  观察组术中出血量显著低于对照组,差异有统计学意义(P=0.004); 观察组淋巴结清扫总数显著少于对照组,差异有统计学意义(P=0.018); 观察组代胃肠管最大直径显著大于对照组,差异有统计学意义(P<0.001); 观察组代胃肠管内钡剂滞留时间显著长于对照组,差异有统计学意义(P<0.001); 观察组术后肛门排气时间、术后开始进食时间、术后住院时间显著短于对照组,差异有统计学意义(P=0.003、0.003、0.026)。观察组术后并发症发生率为13.55%,对照组为20.34%,差异无统计学意义(P=0.326)。观察组术后胃泌素、生长抑素显著高于对照组,差异有统计学意义(P<0.001); 观察组术后胆囊收缩素显著低于对照组,差异有统计学意义(P<0.001)。观察组术后血红蛋白、预后营养指数显著高于对照组,差异有统计学意义(P<0.001)。结论  与全胃切除术联合食管空肠Roux-en-Y吻合术比较,近端胃癌患者接受近端胃大部分切除术联合间置空肠代胃术治疗,术后恢复快,营养状态良好,安全性较好。

关键词：  近端胃大部分切除术; 间置空肠代胃术; 胃癌; 营养状况

Abstract：

Objective  To study the effect of proximal partial gastrectomy and jejunal interposition on postoperative complications, gastrointestinal function and nutritional status of gastric cancer. Methods  118 gastric cancer patients in our department from January 2015 to January 2019 were included in the prospective study. The patients in the control group were treated with total gastrectomy and Roux-en-Y esophagojejunostomy, while the patients in the observation group were treated with proximal gastrectomy and jejunal interposition. Compared two groups of operation time, intraoperative blood loss, the total number of lymph node cleaning, gastric tube diameter, generation gastrointestinal barium retention time, postoperative anal exhaust time, postoperative began eating time, postoperative hospital stay, and the analysis of two groups of postoperative complications and compare the two groups before and after surgery serum gastric secrete element, the gallbladder contraction, somatostatin, gastric dynamic element level, total protein, hemoglobin, serum albumin and prognosis of nutrition index. Results  The amount of bleeding in the observation group was significantly lower than that in the control group (P=0.004); The total number of lymphadenectomy in the observation group was significantly lower than that in the control group (P=0.018); The maximum diameter of gastrointestinal tract in the observation group was significantly larger than that in the control group (P<0.001);The retention time of barium in the gastrointestinal tract of the observation group was significantly longer than that of the control group (P<0.001); The time of anal exhaust, eating and hospitalization in the observation group were significantly shorter than those in the control group. The incidence of postoperative complications was 13.55% in the observation group and 20.34% in the control group (P=0.326). Gastrin and somatostatin in the observation group were significantly higher than those in the control group (P<0.001); The cholecystokinin in the observation group was significantly lower than that in the control group (P<0.001). Postoperative hemoglobin and prognostic nutritional index in the observation group were significantly higher than those in the control group, with statistically significant differences (P<0.001). Conclusions  Compared with total gastrectomy combined with esophagojejunal Roux-en-Y anastomosis, proximal gastrectomy combined with interposition of jejunum for gastric replacement is a safe and effective method for patients with proximal gastric cancer.

Key Words:  Proximal gastrectomy; Jejunal interposition; Gastric cancer; Nutritional status