CAJ | 학술논문

目的评估远端胃大部分切除术后连续空肠间置对比格犬术后的营养状况、肌电活动及胃肠道排空的影响.方法对30只比格犬行远端胃大部分切除术,通过连续空肠间置(连续间置组,9只)、毕Ⅰ式吻合(毕Ⅰ组,6只)、毕Ⅱ式吻合(毕Ⅱ组,7只)和孤立间置(孤立间置组,8只)4种不同方式进行消化道重建,比较术后4组实验犬的体质量、血常规、肝功能、肌电活动及胃肠道排空时间.结果术后12周,连续间置组实验犬体质量为(9.65±1.54)kg,明显高于其他3组[毕Ⅰ组(9.25±1.76)kg,毕Ⅱ组(9.31±1.54)kg,孤立间置组(7.77±1.46)kg,均P＜0.05].术后4周,连续间置组实验犬预后营养指数为2671.9±49.9,明显高于孤立间置组(2440.9±54.3,P＜0.05)和毕Ⅱ组(2555.9±54.7,P＜0.05),但与毕Ⅰ组(2791.8±54.3)比较,差异则无统计学意义(P＞0.05).术后6周,连续间置组空腹及餐后空肠起搏频率均显著高于毕Ⅱ组和孤立间置组(P＜0.05),但与毕Ⅰ组比较差异无统计学意义(P＞0.05);连续间置组空腹及餐后反口方向起搏频率则显著高于其他3组(P＜0.05).连续间置组、毕Ⅰ组、毕Ⅱ组和孤立间置组食物排空率分别为95.4%、91.3%、93.1%和94.2%,差异无统计学意义(P＞0.05).然而,与毕Ⅰ组和毕Ⅱ组比较,连续间置组手术时间更长、术后腹腔粘连更重、恢复正常饮食时间更慢(均P＜0.05).结论对于远端胃大部切除术后不能行毕Ⅰ式吻合重建者,可优先考虑连续性空肠间置.
목적 평고원단위대부분절제술후련속공장간치대비격견술후적영양상황、기전활동급위장도배공적영향.방법 대30지비격견행원단위대부분절제술,통과련속공장간치(련속간치조,9지)、필Ⅰ식문합(필Ⅰ조,6지)、필Ⅱ식문합(필Ⅱ조,7지)화고립간치(고립간치조,8지)4충불동방식진행소화도중건,비교술후4조실험견적체질량、혈상규、간공능、기전활동급위장도배공시간.결과 술후12주,련속간치조실험견체질량위(9.65±1.54)kg,명현고우기타3조[필Ⅰ조(9.25±1.76)kg,필Ⅱ조(9.31±1.54)kg,고립간치조(7.77±1.46)kg,균P＜0.05].술후4주,련속간치조실험견예후영양지수위2671.9±49.9,명현고우고립간치조(2440.9±54.3,P＜0.05)화필Ⅱ조(2555.9±54.7,P＜0.05),단여필Ⅰ조(2791.8±54.3)비교,차이칙무통계학의의(P＞0.05).술후6주,련속간치조공복급찬후공장기박빈솔균현저고우필Ⅱ조화고립간치조(P＜0.05),단여필Ⅰ조비교차이무통계학의의(P＞0.05);련속간치조공복급찬후반구방향기박빈솔칙현저고우기타3조(P＜0.05).련속간치조、필Ⅰ조、필Ⅱ조화고립간치조식물배공솔분별위95.4%、91.3%、93.1%화94.2%,차이무통계학의의(P＞0.05).연이,여필Ⅰ조화필Ⅱ조비교,련속간치조수술시간경장、술후복강점련경중、회복정상음식시간경만(균P＜0.05).결론 대우원단위대부절제술후불능행필Ⅰ식문합중건자,가우선고필련속성공장간치.
Objective To evaluate nutritional status, myoelectrical activity, and gastrointestinal tract emptying capacity after integral continuous jejunal interposition following subtotal gastrectomy.Methods According to different re-construction techniques, 30 Beagle dogs were divided into four groups after subtotal distal gastrectomy: group 1 (n=9, integral continuous jejunal interposition), group 2 (n=6, Billroth Ⅰ ), group 3(n=7, Billroth Ⅱ ), group 4(n=8, isolated jejunal interposition). Blood cell counts, liver function, myoelectrical activity and the rate of gastrointestinal tract emptying were compared among the four groups. Results At week 12 after operation, the body weight in group 1 [(9.65±1.54) kg]was significantly higher than that in group 2 [(9.25±1.76) kg], group 3 [(9.31±1.54) kg]and group 4 [(7.77±1.46) kg]. At week 4, the prognostic nutritional index in group 1 (2671.9±49.9) was significantly higher than that in group 3 (2555.9±54.7) and group 4 (2440.9±54.3), but similar to that in group 2(2791.8±54.3). At week 6, the fasting and postprandial frequency of jejunal pacesetter potentials in group 1 were higher than those in group 3 and group 4 (P＜0.05) but comparable with those in group 2. The emptying rate of food in the four groups were 95.4%,91.3%, 93.1% and 94.2%, respectively and there were no significant differences (P＞0.05). However,as compared with group 2 and group 3, group 1 had longer operative time and later regular diet resumption, more severe abdominal adhesion (P＜0.05). Conclusion Continuous jejunal interposition should be considered when Billroth Ⅰ is not feasible after subtotal gastrectomy.