全胃切除空肠P袢代胃术治疗胃底贲门癌的临床疗效
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摘要
目的探讨全胃切除空肠P袢代胃术治疗胃底贲门癌的临床疗效。方法选取2012年5月—2017年5月在江苏省徐州市丰县人民医院收治的80例胃底贲门癌患者,随机分为观察组和对照组,每组40例。对照组使用常规近侧胃切除术治疗,观察组使用全胃切除空肠P袢代胃术治疗。比较两组患者的各项手术指标、术后进食情况、术后各营养指标情况、术后并发症发生率、转移复发及生存情况。结果观察组手术时间、术中出血量、切口愈合时间、住院时间与对照组比较,差异无统计学意义(P> 0.05);观察组术后3个月、6个月、12个月的胃肠排空时间明显长于对照组,而每次饮食量明显高于对照组,每日饮食次数明显少于对照组(P <0.05);观察组术后3个月、6个月、12个月的血红蛋白、白蛋白、总蛋白水平明显高于对照组(P <0.05);观察组术后胃排空障碍、倾倒综合征、营养不良、食欲不振、胸腔感染、膈下脓肿、肠梗阻等并发症发生率明显低于对照组(P <0.05);观察组1年内复发率、转移率、死亡率明显低于对照组(P <0.05)。结论全胃切除空肠P袢代胃术治疗胃底贲门癌的临床疗效显著,能够保留消化系统储存食物及蠕动的功能,延迟胃排空,增强营养吸收,且并发症发生率低,复发及转移率低,术后生活质量高,具有积极的临床意义。
Objective To investigate the clinical efficacy of total gastrectomy for jejunal P-stomach surgery for gastric cardia and gastric cardia cancer.Methods Eighty patients with gastric cardia cancer admitted to Fengxian People's Hospital of Xuzhou City,Jiangsu Province from May 2012 to May 2017 were randomly divided into observation group and control group,with 40 cases in each group.The control group was treated with conventional proximal gastrectomy,and the observation group was treated with total gastrectomy for jejunum P.The surgical indexes,postoperative feeding,postoperative nutritional status,postoperative complication rate,metastasis recurrence and survival were compared between the two groups.Results There was no significant difference in the operation time,intraoperative blood loss,incision healing time and hospitalization time between the observation group and the control group(P>0.05).The observation group had gastrointestinal findings at 3 months,6 months and 12 months after operation.The emptying time was significantly longer than that of the control group,and the amount of each diet was significantly higher than that of the control group.The daily diet was significantly less than the control group(P<0.05).The observation group was 3 months,6 months,and 12 months after the operation.The levels of hemoglobin,albumin and total protein were significantly higher than those in the control group(P<0.05).Postoperative gastric emptying disorder,dumping syndrome,malnutrition,loss of appetite,chest infection,underarm abscess,intestinal obstruction and other complications were observed in the observation group.The incidence was significantly lower than that of the control group(P<0.05).The recurrence rate,metastasis rate and mortality of the observation group were significantly lower than those of the control group within 1 year(P<0.05).Conclusion The general curative effect of total gastro-intestinal jejunal P-stomach surgery for gastric cardia cancer is significant.It can preserve the function of food and peristalsis in the digestive system,delay gastric emptying,enhance nutrient absorption,and have low complication rate and recurrence.The low transfer rate and high quality of postoperative life have positive clinical significance.
Objective To investigate the clinical efficacy of total gastrectomy for jejunal P-stomach surgery for gastric cardia and gastric cardia cancer.Methods Eighty patients with gastric cardia cancer admitted to Fengxian People's Hospital of Xuzhou City,Jiangsu Province from May 2012 to May 2017 were randomly divided into observation group and control group,with 40 cases in each group.The control group was treated with conventional proximal gastrectomy,and the observation group was treated with total gastrectomy for jejunum P.The surgical indexes,postoperative feeding,postoperative nutritional status,postoperative complication rate,metastasis recurrence and survival were compared between the two groups.Results There was no significant difference in the operation time,intraoperative blood loss,incision healing time and hospitalization time between the observation group and the control group(P>0.05).The observation group had gastrointestinal findings at 3 months,6 months and 12 months after operation.The emptying time was significantly longer than that of the control group,and the amount of each diet was significantly higher than that of the control group.The daily diet was significantly less than the control group(P<0.05).The observation group was 3 months,6 months,and 12 months after the operation.The levels of hemoglobin,albumin and total protein were significantly higher than those in the control group(P<0.05).Postoperative gastric emptying disorder,dumping syndrome,malnutrition,loss of appetite,chest infection,underarm abscess,intestinal obstruction and other complications were observed in the observation group.The incidence was significantly lower than that of the control group(P<0.05).The recurrence rate,metastasis rate and mortality of the observation group were significantly lower than those of the control group within 1 year(P<0.05).Conclusion The general curative effect of total gastro-intestinal jejunal P-stomach surgery for gastric cardia cancer is significant.It can preserve the function of food and peristalsis in the digestive system,delay gastric emptying,enhance nutrient absorption,and have low complication rate and recurrence.The low transfer rate and high quality of postoperative life have positive clinical significance.
引文
[1]黄志坚,叶文飞.全胃切除空肠P袢代胃术治疗胃底贲门癌的临床疗效研究[J].中华临床医师杂志(电子版),2014,8(11):1993-1996.
[2]刘全新.全胃切除空肠P袢代胃术和近侧胃大部切除术治疗胃底贲门癌的对比[J].当代医学,2011,17(22):73-74.
[3]李建华,韩玲.全胃切除空肠P袢代胃术治疗胃底贲门癌的临床效果分析[J].现代预防医学,2012,39(9):2366-2367.
[4]李建华,韩玲.全胃切除空肠P袢代胃术治疗胃底贲门癌的临床效果分析[J].现代预防医学,2012,39(9):38-39.
[5]范宇洋,刘东举,郝帅,等.全胃切除空肠P袢代胃术治疗胃底贲门癌的疗效评价[J].航空航天医学杂志,2018,29(3):299-300.
[6]郭利光.全胃切除空肠P袢代胃术治疗胃底贲门癌的临床效果分析[J].河南医学研究,2015,24(1):48-49.
[7]武洪友,苑峰斌,张跃.空肠P袢代胃吻合术与标准Rouxen-Y吻合术治疗胃底贲门癌临床疗效和安全性[J].河北医药,2013,35(12):1813-1814.
[8]郭德洋.胃底贲门癌全胃切除空肠P袢代胃术后患者营养状况分析[J].河南外科学杂志,2016,22(6):78-79.
[9]刘晓强,朱德隆,崔建勇.空肠P袢代胃术在胃大部切除术后食管下段、贲门癌手术中的临床应用[J].肿瘤学杂志,2008,14(6):438-439.
[10]成亚农,李弼鹏.胃癌全胃切除ρ型空肠原位间置代胃术的临床观察[J].中国普通外科杂志,2012,21(4):477-478.
[11]贾晓斌,吉锋英,毕红革.胃底贲门癌根治术后不同消化道重建方式的效果比较[J].陕西医学杂志,2015,44(12):1585-1586.
[12]Czupryniak L,Pawowski M,Szymanski D,et al.Plasma glucose after stomach or jejunum glucose infusion in Roux-en-Ygastric bypass patients-a possible implication for early satiety mechanism[J].Exp Clin Endocrinol Diabetes,2011,119(3):186-189.
[13]田景中.根治性全胃切除空肠间置代胃术对胃癌的临床疗效分析[J].实用癌症杂志,2013,28(4):379-381.
[14]温仁祝,陈铭伍,郭建极,等.食管-空肠吻合术治疗中晚期胃底贲门癌20例报告[J].广西医科大学学报,2014,31(5):816-817.
[15]张斌,姬社青,花亚伟等.空肠间置术在近端胃癌根治术中的应用[J].中华肿瘤杂志,2013,35(7):530-533.
[16]Chavarriaga LF,Cook MW,White B,et al.Transoral Technique for Gastrojejunostomy in Laparoscopic Roux-en-YGastric Bypass(LRYGBP)Can Accelerate Learning Curve and Reduce Cost[J].Obes Surg,2010,20(7):846-850.
[2]刘全新.全胃切除空肠P袢代胃术和近侧胃大部切除术治疗胃底贲门癌的对比[J].当代医学,2011,17(22):73-74.
[3]李建华,韩玲.全胃切除空肠P袢代胃术治疗胃底贲门癌的临床效果分析[J].现代预防医学,2012,39(9):2366-2367.
[4]李建华,韩玲.全胃切除空肠P袢代胃术治疗胃底贲门癌的临床效果分析[J].现代预防医学,2012,39(9):38-39.
[5]范宇洋,刘东举,郝帅,等.全胃切除空肠P袢代胃术治疗胃底贲门癌的疗效评价[J].航空航天医学杂志,2018,29(3):299-300.
[6]郭利光.全胃切除空肠P袢代胃术治疗胃底贲门癌的临床效果分析[J].河南医学研究,2015,24(1):48-49.
[7]武洪友,苑峰斌,张跃.空肠P袢代胃吻合术与标准Rouxen-Y吻合术治疗胃底贲门癌临床疗效和安全性[J].河北医药,2013,35(12):1813-1814.
[8]郭德洋.胃底贲门癌全胃切除空肠P袢代胃术后患者营养状况分析[J].河南外科学杂志,2016,22(6):78-79.
[9]刘晓强,朱德隆,崔建勇.空肠P袢代胃术在胃大部切除术后食管下段、贲门癌手术中的临床应用[J].肿瘤学杂志,2008,14(6):438-439.
[10]成亚农,李弼鹏.胃癌全胃切除ρ型空肠原位间置代胃术的临床观察[J].中国普通外科杂志,2012,21(4):477-478.
[11]贾晓斌,吉锋英,毕红革.胃底贲门癌根治术后不同消化道重建方式的效果比较[J].陕西医学杂志,2015,44(12):1585-1586.
[12]Czupryniak L,Pawowski M,Szymanski D,et al.Plasma glucose after stomach or jejunum glucose infusion in Roux-en-Ygastric bypass patients-a possible implication for early satiety mechanism[J].Exp Clin Endocrinol Diabetes,2011,119(3):186-189.
[13]田景中.根治性全胃切除空肠间置代胃术对胃癌的临床疗效分析[J].实用癌症杂志,2013,28(4):379-381.
[14]温仁祝,陈铭伍,郭建极,等.食管-空肠吻合术治疗中晚期胃底贲门癌20例报告[J].广西医科大学学报,2014,31(5):816-817.
[15]张斌,姬社青,花亚伟等.空肠间置术在近端胃癌根治术中的应用[J].中华肿瘤杂志,2013,35(7):530-533.
[16]Chavarriaga LF,Cook MW,White B,et al.Transoral Technique for Gastrojejunostomy in Laparoscopic Roux-en-YGastric Bypass(LRYGBP)Can Accelerate Learning Curve and Reduce Cost[J].Obes Surg,2010,20(7):846-850.