摘要
目的观察胃癌术后不同残胃患者胃肠激素及机体组成的变化。方法选择行胃癌根治术患者38例,分为远端胃切除组、近端胃切除组及全胃切除组3组,另设9例正常志愿者作为对照。所有患者分别于术前及术后1周、2周和1个月监测机体营养状态及胃肠症状评分,观察患者术后肛门排气和排便时间、术后住院时间及并发症发生情况。术后1个月检测各组餐前及餐后30 min血清胃肠激素水平。结果远端胃切除组、近端胃切除组及全胃切除组术后1个月生长抑素(SS)、胆囊收缩素(CCK)及胃动素(MTL)的餐前水平较对照者均明显升高(P<0.01);各组餐后30 min胃肠激素分泌量较餐前均明显增加(P<0.01);CCK水平在远端胃切除组和全胃切除组较近端胃切除组高(P<0.01)。术后体重均明显下降,机体组成改变明显;术后1个月全胃切除组体重下降最明显(P<0.01);瘦组织群下降幅度全胃切除组>近端胃切除组>远端胃切除组;术后1个月3组间的水肿指数(细胞外液/总体液×100%)差异有统计学意义(P<0.01),全胃切除组组织水肿最明显。全胃切除组术后肛门排气、排便时间及平均住院时间均较其余2组明显延长(P<0.05);术后胃肠症状评分3组间差异有统计学意义(P<0.05)。结论胃癌术后不同残胃患者胃肠激素及机体组成变化不同,以全胃切除患者最明显;SS、CCK及MTL基础水平均显著升高;全胃切除患者的体重和FFM下降及组织水肿最明显。
Objective To investigate the changes of gastrointestinal hormone and body composition in patients with gastric cancer after gastrectomy. Methods Thirty-eight patients with gastric cancer were divided into three groups： distal gastrectomy group, proximal gastrectomy group and total gastrectomy group and 9 volunteers as control group. The nutrition status and gastrointestinal function were evaluated by four times. The time of postoperative first anal exsufflation and defacation, hospital stay and complications were recorded, and the pre-meal and the post-meal level of gastrointestinal hormones 1 month after operation were detected. Results Compared with control group, the basic levels of somatostatin （SS）, cholecystokinin （CCK） and motilin （MTL） of distal gastrectomy group, proximal gastrectomy group and total gastrectomy group significantly increased （P〈0.01）. The post-meal level of gastrointestinal hormones significantly increased as compared with the pre-meal level in each group （P〈0.01）. The CCK in proximal gastrectomy group was lower than that of distal gastrectomy group and total gastrectomy group （P（0.01）. The postoperative body weight and body composition in each group decreased. One month after operation, patients of total gastrectomy group got the lowest body weight （P〈0.01）. The decreasing level of fat free mass （FFM） was listed by total gastrectomy group, proximal gastrectomy group and distal gastrectomy group. The edema index had significant difference in distal gastrectomy group, proximal gastrectomy group and total gastrectomy group （P〈0. 01）, and total gastrectomy group was the most obvious. The postoperative passing flatus and defecation time and average hospital stay in total gastrectomy group were significantly prolonged （P〈0.05）. The gastrointestinal symptoms score among three groups was significantly different （P〈0.05）. Conclusion There are different changes of gastrointestinal hormone and body composition in patients with gastric cancer after different gastrectomy, the basic levels of SS, CCK and MTL of distal gastrectomy group, proximal gastrectomy group and total gastrectomy group are higher than those of control group. The CCK of proximal gastrectomy group is lower than that of distal gastrectomy group and total gastreetomy group. Patients received total gastrecto- my lose much body weight and FFM and get higher edema index.
出处
《中国普外基础与临床杂志》
CAS
2009年第4期290-295,共6页
Chinese Journal of Bases and Clinics In General Surgery
关键词
残胃
胃肠激素
营养状态
机体组成
Remnant stomach
Gastrointestinal hormone
Nutrition status
Body composition
