CAJ | 학술논문

目的探讨远端胃次全切除术后合理的消化道重建方式.方法将32只Beagle犬以随机数字表法分为4组(实验组A、B、C和对照组),每组8只.A、B、C组远端胃次全切除术后分别行残胃-十二指肠-连续性空肠间置、毕Ⅱ式、Roux-en-Y式消化道重建,对照组施以假手术.术后连续观察12周,比较各组手术前后摄食、体重、预后营养指数(PNI)和外周血Ghrelin浓度的变化.结果 A、B、C组术后摄食量、体重及PNI均较术前下降,然后缓慢回升,术后12周,A组摄食量、体重及PNI(26.8±3.3)均优于B组(25.4±3.0)和C组(25.6±3.0),差异有统计学意义(P＜0.05),而B、C组间比较差异无统计学意义.A、B、C组术后第1天外周血Ghrelin浓度均较术前明显下降,1周后,Ghrelin浓度开始回升,术后12周,A组Ghrelin浓度[(280±15)pg/ml]明显高于B组[(180±10)pg/ml]和C组[(185±10)pg/ml,均P＜0.05)].对照组手术前后食量、PNI及血Ghrelin浓度无明显变化(P＞0.05),术后12周后体重明显高于术前(P＜0.05).结论远端胃次全切除术后,残胃-十二指肠-连续性空肠间置术恢复了十二指肠生理通道,术后摄食量、体重及PNI恢复更快、促食激素Ghrelin代偿性分泌更明显,为一种较理想的重建术式.
목적 탐토원단위차전절제술후합리적소화도중건방식.방법 장32지Beagle견이수궤수자표법분위4조(실험조A、B、C화대조조),매조8지.A、B、C조원단위차전절제술후분별행잔위-십이지장-련속성공장간치、필Ⅱ식、Roux-en-Y식소화도중건,대조조시이가수술.술후련속관찰12주,비교각조수술전후섭식、체중、예후영양지수(PNI)화외주혈Ghrelin농도적변화.결과 A、B、C조술후섭식량、체중급PNI균교술전하강,연후완만회승,술후12주,A조섭식량、체중급PNI(26.8±3.3)균우우B조(25.4±3.0)화C조(25.6±3.0),차이유통계학의의(P＜0.05),이B、C조간비교차이무통계학의의.A、B、C조술후제1천외주혈Ghrelin농도균교술전명현하강,1주후,Ghrelin농도개시회승,술후12주,A조Ghrelin농도[(280±15)pg/ml]명현고우B조[(180±10)pg/ml]화C조[(185±10)pg/ml,균P＜0.05)].대조조수술전후식량、PNI급혈Ghrelin농도무명현변화(P＞0.05),술후12주후체중명현고우술전(P＜0.05).결론 원단위차전절제술후,잔위-십이지장-련속성공장간치술회복료십이지장생리통도,술후섭식량、체중급PNI회복경쾌、촉식격소Ghrelin대상성분비경명현,위일충교이상적중건술식.
Objective To explore an ideal procedure of alimentary tract reconstructions after subtotal distal gastrectomy. Methods Thirty-two healthy adult beagle dogs were randomly divided into experimental groups A, B, C and control group (n= 8). Groups A, B, C operated by subtotal distal gastrectomy underwent 3 different reconstruction methods: continual jejunal interposition (CJI), Billroth Ⅱ and Roux-en-Y. The control group received a sham operation. Dogs were observed for 12 weeks postoperation. The different parameters of body weight, food intake, PNI (prognostic nutritional index) and peripheral blood concentration of ghrelin were measured in 4 groups. Results The body weight, food intake and PNI in Groups A, B, C decreased significantly at post-operation versus pre-operation. There was a slow elevation of body weight, food intake and PNI at Week 12. Group A was significantly better than Groups B and C (P ＜ 0. 05) while there was no significant difference between Groups B and C. The plasma ghrelin concentrations in Groups A, B, C were significantly reduced at Day 1 post-operation versus pre-operation.But no difference was observed among Groups A, B and C. However an elevated ghrelin concentration was observed at Week 1 post-operation. At Week 12 post-operation, the plasma ghrelin concentration in Group A increased significantly versus Groups B and C (both P ＜0. 05). However, the plasma ghrelin concentration,food intake and PNI were not significantly changed in control group (P ＞ 0. 05). Conclusions The CJI reconstruction procedure is ideally suited for the preservation of duodenal passage after subtotal distal gastrectomy. Subsequently it leads to a significant elevation of circulating ghrelin concentration and a rapid post-operative recovery of food intake, body weight and PNI.