摘要
目的探讨间置空肠术与两种常见消化道重建方式[全胃切除＋食管空肠鲁氏Y形吻合（Roux-en-Y）术式、近端胃大部切除＋食管残胃吻合术式]对近端胃癌患者术后生活质量的影响。方法选取2011年3月-2014年9月间内蒙古自治区巴彦淖尔市医院胃肠外科收治的近端胃癌患者109例为研究对象,根据术式不同分为三组：实验组（近端胃大部切除＋间置空肠组,A组）、对照组1（全胃切除＋食管-空肠Roux-en-Y组,B组）、对照组2（近端胃大部切除＋食管残胃端侧吻合组,C组）。分别比较实验组与对照组1、2患者手术前后血清胃肠激素[胃泌素（GAS）、胃动素（MTL）、胆囊收缩素（CCK）、生长抑素（SS）]含量变化、术前及术后6个月营养学指标（血红蛋白、白蛋白、总蛋白）和预后营养指数（PNI）、术后生活质量[Visick评分、胃肠道症状评分（GSRS）]等方面的差别。结果术后6个月,A组患者较B组、C组的GAS、SS水平升高,CCK水平降低,差异有统计学意义（P〈0.05）,而MTL水平比较差异均无统计学意义（P〉0.05）;B组患者与C组患者比较,GAS与CCK水平降低,差异有统计学意义（P〈0.05）,而SS、MTL水平比较差异均无统计学意义（P〉0.05）。A组的血红蛋白、PNI指数较B组、C组患者升高,接近正常水平,差异有统计学意义（P〈0.05）。A组及B组患者的Visick评分为Ⅰ级的人数较C组患者显著增多,而Ⅱ~Ⅲ级人数减少,差异有统计学意义（P〈0.05）;A组患者的胃肠道症状（GSRS）评分较B组、C组患者降低,差异有统计学意义（P〈0.05）,而B组、C组患者GSRS评分比较差异无统计学意义（P〉0.05）。结论对于近端胃癌患者采用近端胃大部切除＋空肠间置术,术后患者恢复较快,预后营养状态较好,生活质量较高。
Objective To investigate the effect of jejunal interposition surgery and two common digestive tract reconstruction methods on the postoperative quality of life in patients with proximal gastric cancer. Methods Total 109 proximal stomach cancer patients hospitalized in Inner Mongolia Bayannur City Hospital from March 2011 to September2014 were collected. The patients were divided into three groups： experimental group（proximal subtotal gastrectomy plus the jejunal interposition surgery, group A）, the control group 1（total gastrectomy plus esophagus jejunum Roux-enY anastomosis, group B）, and the control group 2（proximal subtotal gastrectomy plus the esophageal gastric remnant anastomosis, group C）. The changes of serum gastrointestinal hormone [gastrin（GAS）, motilin（MTL）, cholecystokinin（CCK）,somatostatin（SS）], Prognostic Nutritional Index（PNI） and quality of life were compared between three groups. Results Compared with group B and C, the levels of GAS, SS increased and CCK decreased in group A（P〈0.05）, but there was no statistical significance in the MTL level（P〈0.05） in postoperative 6 months. Compared with group C, the levels of GAS, CCK decreased in group B（P〈0.05）, but there was no statistical significance in the SS, MTL levels（P〈0.05）. Compared with group B and C, the level of hemoglobin（HB） and PNI index increased in group A（P〈0.05） in postoperative 6 months. The quality of life in postoperative 6 month showed that compared with group C, there were more patients with Visick Score 1 and less patients with Visick Score 2 or 3 in group A and B（P〈0.05）. Group A had less GSRS Score than that in group B and C（P〈0.05）, but there was no statistical significance of GSRS Score between group B and C（P〈0.05）. Conclusion The patients with proximal stomach cancer who received proximal subtotal gastrectomy plus jejunal interposition surgery show quicker recovery, better nutritional status and quality of life.
出处
《中国医药导报》
CAS
2016年第11期112-116,共5页
China Medical Herald
基金
内蒙古自治区科技厅应用与研究开发计划项目(20130439)
关键词
近端胃癌
间置空肠术
胃肠激素
营养指标
Proximal stomach cancer
Jejunal interposition surgery
Gastrointestinal hormones
Nutritive index
