CAJ | 학술논문

目的：对比远端胃大部分切除术后行连续性空肠间置术与Bil rothⅠ式及Roux- en- Y式吻合术的临床效果。方法回顾性分析2012年1月至2013年6月接受手术的远端胃癌患者95例，按不同消化道重建方式分为3组。A组30例患者行连续性空肠间置术，B组32例行Bil rothⅠ式吻合术，C组33例行Roux- en- Y式吻合术。比较3组患者术前预后营养指数（PNI）、手术时间、术后6个月及1年并发症发生率、进食量、血浆白蛋白水平、体重及Visick分级指数。结果3组患者术前PNI均无统计学差异（均P＞0.05）。A组患者手术时间与B组无明显差异，且均明显少于C组的手术时间（均P＜0.05）。术后6个月及术后1年3组患者的进食量、体重及营养状况的恢复均无统计学差异（均P＞0.05）。A组患者术后腹胀情况明显少于C组（P＜0.05），胆汁反流性胃炎明显少于B组（P＜0.05）。结论胃大部分切除术后连续性空肠间置，安全有效，与传统的Bil rothⅠ式及Roux- en- Y式吻合术比较，可缩短手术时间，更快的恢复患者的消化功能，维持消化道正常通路，防止胆汁反流，将有可能成为消化道重建的主要方式之一。
목적：대비원단위대부분절제술후행련속성공장간치술여Bil rothⅠ식급Roux- en- Y식문합술적림상효과。방법회고성분석2012년1월지2013년6월접수수술적원단위암환자95례，안불동소화도중건방식분위3조。A조30례환자행련속성공장간치술，B조32례행Bil rothⅠ식문합술，C조33례행Roux- en- Y식문합술。비교3조환자술전예후영양지수（PNI）、수술시간、술후6개월급1년병발증발생솔、진식량、혈장백단백수평、체중급Visick분급지수。결과3조환자술전PNI균무통계학차이（균P＞0.05）。A조환자수술시간여B조무명현차이，차균명현소우C조적수술시간（균P＜0.05）。술후6개월급술후1년3조환자적진식량、체중급영양상황적회복균무통계학차이（균P＞0.05）。A조환자술후복창정황명현소우C조（P＜0.05），담즙반류성위염명현소우B조（P＜0.05）。결론위대부분절제술후련속성공장간치，안전유효，여전통적Bil rothⅠ식급Roux- en- Y식문합술비교，가축단수술시간，경쾌적회복환자적소화공능，유지소화도정상통로，방지담즙반류，장유가능성위소화도중건적주요방식지일。
Objective To compare the clinical efficacy of different surgical modalities for reconstruction of digestive canal after subtotal gastrectomy. Methods Ninety five patients with gastric cancer underwent subtotal gastrectomy with different surgical modalities for digestive reconstruction:30 patients with continual jejuna interposition (group A), 32 with Bil rothⅠanastomo-sis (group B) and 33 patients with Roux- en- Y anastomosis. The symptom in alimentary canal, visick ranking index, plasma albumin, food- intake and body weight were compared among groups and gastric stump and stoma were inspected by gastroscope in 6 months and 1 year after surgery. Results The PNI showed no significant difference among three groups before operation. There were no significant differences in plasma albumin, food- intake and body weight among 3 groups 6 months and 1 year after surgery. The abdominal distension in group A was less than that in group C, the bile reflux gastritis in group A was less than that in group B. Conclusion Continual jejunal interposition is a safe and effective procedure. Compared with Bil rothⅠanastomosis and Roux- en- Y anastomosis, it can shorten the operation time, keep physiological continuity of digestive canal, avoid bile regurgitation and better restore of digestive function for patients undergoing subtotal gastrectomy.