CAJ | 학술논문

目的比较3S型空肠代胃和P袢型空肠代胃在全胃切除术消化道重建中的临床作用.方法2005年2月至2009年2月间河南科技大学附属第一医院肿瘤科进行全胃切除术85例,其中46例采用3S型空肠代胃、39例P袢型食管空肠Roux-en-Y吻合进行消化道重建,比较两种重建术后6个月的并发症发生情况、营养状况及生活质量.结果两种消化道重建方式手术时间、围手术期并发症发生率及病死率的差异均无统计学意义(P＞0.05).术后6个月,与P袢型空肠代胃组患者相比,3S型空肠代胃组患者倾倒综合征[4.3％(2/46)比10.3％(4/39)]和反流性食管炎[ 10.8％(5/46)比33.3％(13/39)]的发生率均更低,总蛋白[(55.7±3.1)g/L比(50.3±5.1)g/L]、白蛋白[(36.5±3.6) g/L比(31.6±4.4)g/L]、血红蛋白[(120.2±13.4) g/L比(110.4±23.0) g/L]及营养评定指数(73.2±4.8比56.0±6.3)均更高,生活质量(Cuschieri分级)更优,差异均有统计学意义(均P＜0.05).结论 3S型空肠代胃术这一消化道重建方式能有效防止反流性食管炎及倾倒综合征的发生,改善患者的营养状况,提高术后生活质量.
목적 비교3S형공장대위화P번형공장대위재전위절제술소화도중건중적림상작용.방법2005년2월지2009년2월간하남과기대학부속제일의원종류과진행전위절제술85례,기중46례채용3S형공장대위、39례P번형식관공장Roux-en-Y문합진행소화도중건,비교량충중건술후6개월적병발증발생정황、영양상황급생활질량.결과 량충소화도중건방식수술시간、위수술기병발증발생솔급병사솔적차이균무통계학의의(P＞0.05).술후6개월,여P번형공장대위조환자상비,3S형공장대위조환자경도종합정[4.3％(2/46)비10.3％(4/39)]화반류성식관염[ 10.8％(5/46)비33.3％(13/39)]적발생솔균경저,총단백[(55.7±3.1)g/L비(50.3±5.1)g/L]、백단백[(36.5±3.6) g/L비(31.6±4.4)g/L]、혈홍단백[(120.2±13.4) g/L비(110.4±23.0) g/L]급영양평정지수(73.2±4.8비56.0±6.3)균경고,생활질량(Cuschieri분급)경우,차이균유통계학의의(균P＜0.05).결론 3S형공장대위술저일소화도중건방식능유효방지반류성식관염급경도종합정적발생,개선환자적영양상황,제고술후생활질량.
Objective To compare the clinical effect of 3S-type and P-loops digestive reconstruction after total gastrectomy for gastric cancer.Methods From Februray 2005 to Februray 2009,85 cases underwent total gastrectomy in The First Affiliated Hospital of Henan University of Science and Technology.Two types of digestive reconstructionwere performed with 3S-type jejunum (n=46) and P-loops Roux-en-Y esophagojejunostomy (n=39).The postoperative complications,nutrition index and the quality of life at half a year after surgery were comparatively analyzed.Results Two types of digestive reconstruction had no statistical differences in operative time,postoperative complications and mortality (P＞0.05).Compared with P-loops Roux-en-Y esophagojejunostomy at 6 months after operation,3S-type jejunum had a lower incidence in dumping syndrome [4.3％ (2/46)vs.10.3％ (4/39),P＜0.05] and reflux esophagitis [10.8％ (5/46) vs.33.3％ (13/39),P＜0.05].3S-type jejunum was superior to P-loops Roux-en-Y esophagojejunostomy in serum total protein (55.7±3.1 g/L vs 50.3±5.1 g/L,P＜0.05),albumin (36.5±3.6 g/L vs.31.6±4.4 g/L,P＜0.05),hemoglobin (120.2±13.4 g/L vs.110.4±23.0 g/L,P＜0.05),and nutritional assessment index(73.2±4.8 vs.56.0±6.3,P＜0.05).Conclusion Reconstruction of stomach with 3S-type jejunum may be an effective way to prevent reflux esophagitis and dumping syndrome,and to improve the nutritional status and the quality of life.