CAJ | 학술논문

目的：探讨全胃切除食管空肠 Roux‐Y 吻合术和单腔空肠间置术患者消化道动力的变化，并加以比较，为今后临床行全胃切除术后治疗方法提供依据。方法选取2010年1月至2013年6月在重庆市合川区人民医院行全胃切除术生存期达6个月的126例患者作为研究对象，将患者分为两组，观察组（63例）和对照组（63例），另外设63例健康人群作为健康组，对照组给予单腔空肠间置术，观察组行食管空肠 Roux‐Y 吻合术，健康组不施加干预。观察3组在消化道动力方面的不同表现，并加以比较。结果观察组患者体质量、每日进餐次数、每日进食量少于对照组，差异有统计学意义（P＜0．05），两组与健康组比较差异无统计学意义（P＞0．05）。观察组患者出现反流性食管炎、倾倒综合征、嗳气、早饱症等不良反应的人数明显高于对照组，差异有统计学意义（P ＜0．05），两组与健康组比较差异无统计学意义（P ＞0．05）。3组研究对象营养学指标差异无统计学意义（P ＞0．05）。结论Roux‐Y 吻合术营养状况的改善情况不次于单腔空肠间置术，但术后不良反应较多。因此，应根据患者具体情况选择适宜的重建术方法，但应以单腔空肠间置术作为首选方法。
목적：탐토전위절제식관공장 Roux‐Y 문합술화단강공장간치술환자소화도동력적변화，병가이비교，위금후림상행전위절제술후치료방법제공의거。방법선취2010년1월지2013년6월재중경시합천구인민의원행전위절제술생존기체6개월적126례환자작위연구대상，장환자분위량조，관찰조（63례）화대조조（63례），령외설63례건강인군작위건강조，대조조급여단강공장간치술，관찰조행식관공장 Roux‐Y 문합술，건강조불시가간예。관찰3조재소화도동력방면적불동표현，병가이비교。결과관찰조환자체질량、매일진찬차수、매일진식량소우대조조，차이유통계학의의（P＜0．05），량조여건강조비교차이무통계학의의（P＞0．05）。관찰조환자출현반류성식관염、경도종합정、애기、조포증등불량반응적인수명현고우대조조，차이유통계학의의（P ＜0．05），량조여건강조비교차이무통계학의의（P ＞0．05）。3조연구대상영양학지표차이무통계학의의（P ＞0．05）。결론Roux‐Y 문합술영양상황적개선정황불차우단강공장간치술，단술후불량반응교다。인차，응근거환자구체정황선택괄의적중건술방법，단응이단강공장간치술작위수선방법。
Objective To investigate and compare the changes of the dynamics in digestive tract in patients re‐spectively received esophagus jejunum Roux‐Y anastomosis and single pouch jejunum interposition after total gastrec‐tomy ,so as to provide a reference for the treatment after total gastrectomy .Methods From January 2010 to June 2013 ,126 patients with 6‐month survival after total gastrctomy were selected in Hechuan District People′s Hospital and divided into two groups :observation group (n= 63) and control group (n= 63) .63 healthy people were enrolled in normal group at the same time .The patients of control group and observation group were treated by single pouch jejunum interposition and esophagus jejunum Roux‐Y anastomosis ,respectively .Normal group did not exert interven‐tion .The performance of dynamics in digestive tract in three groups were observed and compared .Results Compared with control group ,the weight ,the number of meals per day ,the daily food intake significantly reduced (P< 0 .05) , however ,neither control group nor observation group was significantly different from normal group (P > 0 .05) .In observation group ,the numbers of people with adverse reactions ,such as reflux esophagitis ,dumping syndrome ,belc‐hing and early satiety disease ,were significantly more than control group (P< 0 .05) ,however ,neither control group nor observation group was significantly different from normal group (P> 0 .05) .There was no significant difference of nutrition indicators among three groups (P> 0 .05) .Conclusion The improvement of digestive tract dynamics in patients with esophagus jejunum Roux‐Y anastomosis was as good as the patients with single pouch jejunum interpo‐sition ,however ,patients with esophagus jejunum Roux‐Y anastomosis had more adverse reactions after surgery .Suit‐able reconstruction method should be chose ,according to the patient′s situation ,and single pouch jejunum interposi‐tion should be the preferred method .