贲门癌患者行近端胃大部切除后食管残胃吻合术与全胃切除后食管空肠Roux-Y吻合术疗效比较
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摘要
目的比较贲门癌患者行近端胃大部切除后食管残胃吻合术与全胃切除后食管空肠Roux-Y吻合术的临床效果。方法选择2012年1月至2015年6月惠东县人民医院收治的贲门癌患者110例,其中46例患者行近端胃大部切除后食管残胃吻合术(食管残胃吻合组),64例患者行全胃切除后食管空肠Roux-Y吻合术(Roux-Y吻合组),比较2组患者的手术时间、术后并发症、血清前白蛋白水平及体质量指数。结果食管残胃吻合组和Roux-Y吻合组患者的手术时间分别为(166.4±19.3)、(123.4±18.9)min,Roux-Y吻合组患者的手术时间显著短于食管残胃吻合组(P<0.05)。术后3、6、12个月,食管残胃吻合组患者血清前白蛋白及体质量指数均显著高于Roux-Y吻合组(P<0.05)。结论贲门癌患者行近端胃大部切除后食管残胃吻合术与全胃切除后食管空肠Roux-Y吻合术均能够达到较好的手术效果,但全胃切除后食管空肠Roux-Y吻合术手术时间较短,而近端胃大部切除后食管残胃吻合术能更好地改善术后患者的营养状态,提高生存质量,更适合早中期的近端胃癌手术患者。
Objective To compare the effect of esophagogastrostomy after proximal subtotal gastrectomy and Roux-Y esophagojejunostomy after total gastrectomy in patients with carcinoma of gastric cardia. Methods Among the 110 patients with carcinoma of gastric cardia who were selected in Huidong People's Hospital from January 2012 to June 2015,46 patients were performed with esophagogastrostomy after proximal subtotal gastrectomy( esophagogastrostomy group),and 64 patients underwent Roux-Y esophagojejunostomy after total gastrectomy( Roux-Y esophagojejunostomy group). The operation time,postoperative complications,serum prealbumin level and body mass index were compared between the two groups. Results The operation time in esophagogastrostomy group and Roux-Y esophagojejunostomy group was( 166. 4 ± 19. 3) and( 123. 4 ± 18. 9) minutes,the operation time in Roux-Y esophagojejunostomy group was significantly shorter than that in esophagogastrostomy group( P < 0. 05). The level serum prealbumin and body mass index in esophagogastrostomy group were significantly higher than those in Roux-Y esophagojejunostomy group at 3,6 and 12 months after operation( P < 0. 05). Conclusion The esophagogastrostomy after proximal subtotal gastrectomy and Roux-Y esophagojejunostomy after total gastrectomy for carcinoma of gastric cardia can achieve good results. The operation time of Roux-Y esophagojejunostomy after total gastrectomy is shorter. But the esophagogastrostomy after proximal subtotal gastrectomy can improve the nutritional status of patients,improve the quality of life. The esophagogastrostomy is more suitable for patients with early and middle stage proximal gastric cancer.
Objective To compare the effect of esophagogastrostomy after proximal subtotal gastrectomy and Roux-Y esophagojejunostomy after total gastrectomy in patients with carcinoma of gastric cardia. Methods Among the 110 patients with carcinoma of gastric cardia who were selected in Huidong People's Hospital from January 2012 to June 2015,46 patients were performed with esophagogastrostomy after proximal subtotal gastrectomy( esophagogastrostomy group),and 64 patients underwent Roux-Y esophagojejunostomy after total gastrectomy( Roux-Y esophagojejunostomy group). The operation time,postoperative complications,serum prealbumin level and body mass index were compared between the two groups. Results The operation time in esophagogastrostomy group and Roux-Y esophagojejunostomy group was( 166. 4 ± 19. 3) and( 123. 4 ± 18. 9) minutes,the operation time in Roux-Y esophagojejunostomy group was significantly shorter than that in esophagogastrostomy group( P < 0. 05). The level serum prealbumin and body mass index in esophagogastrostomy group were significantly higher than those in Roux-Y esophagojejunostomy group at 3,6 and 12 months after operation( P < 0. 05). Conclusion The esophagogastrostomy after proximal subtotal gastrectomy and Roux-Y esophagojejunostomy after total gastrectomy for carcinoma of gastric cardia can achieve good results. The operation time of Roux-Y esophagojejunostomy after total gastrectomy is shorter. But the esophagogastrostomy after proximal subtotal gastrectomy can improve the nutritional status of patients,improve the quality of life. The esophagogastrostomy is more suitable for patients with early and middle stage proximal gastric cancer.
引文
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[11]柴芳,高向楠,王俊,等.Roux-en-Y胃旁路术对2型糖尿病大鼠脂联素及胰岛凋亡蛋白表达的影响[J].天津医药,2015,43(8):860-863.
[2]孙井军,周琦,尤承忠,等.大鼠胃空肠Roux-en-Y吻合口Cajal间质细胞再生与胃排空功能关系[J].中华外科杂志,2015,53(4):310-313.
[3]KIM B S,YOOK J H,CHOI Y B.Comparison of early out-comes of intracorporeal and extracorporeal gastroduodenostomy after laparoscopic distal gastrectomy for gastric cancer[J].J Laparoendosc Adv Surg Tech,2011,21(5):387-391.
[4]HOYA Y,MITSUMORI N,YANAGA K.The advantages and disadvantages of a Roux-en-Y reconstruction after a distal gastrectomy for gastric cancer[J].Surg Today,2009,39(8):647-651.
[5]DE STEUR W O,DIKKEN J L,HARTGRINK H H.Lymph node dissection in resectable advanced gastric cancer[J].Dig Surg,2013,30(2):96-103.
[6]赵鹏伟,黄建钊,芶欣,等.Mirizii综合征(Ⅲ型)合并梗阻性黄疸1例报道[J].中国民族民间医药,2015,24(4):67-68.
[7]何国庆,唐应明,罗淼,等.腹腔镜辅助治疗先天性胆总管囊肿25例体会[J].贵州医药,2012,36(9):808-810.
[8]王黔,于扬,赵代伟,等.胃肠吻合器及切割缝合器在全胃切除空肠U型折叠代胃Roux-en-Y吻合术中的应用[J].贵州医药,2003,27(4):342-343.
[9]HRIBAL M L,FIORENTINO T V,SESTI G.Role of C reactive protein(CRP)in leptin resistance[J].Curr Pharm Des,2014,20(4):609-615.
[10]LIAO W,LIN J X,LEONARD W J.IL-2 family cytokines:new insights into the complex roles of IL-2 as a broad regulator of T helper cell differentiation[J].Curr Opin Immunol,2011,23(5):598-604.
[11]柴芳,高向楠,王俊,等.Roux-en-Y胃旁路术对2型糖尿病大鼠脂联素及胰岛凋亡蛋白表达的影响[J].天津医药,2015,43(8):860-863.