胃癌全胃切除术后两种消化道重建术式的比较

目的：探讨P型空肠襻食管空肠Roux—en—Y吻合术和改良“P”形空肠间置代胃术（mPJIP）两种不同消化道重建术式的临床疗效，并对术后两种术式的效果进行统计分析。方法：胃癌行全胃切除术患者共146例，随机将其分为两组：P型空肠襻食管空肠Roux—en—Y吻合术（PRY）组72例和改良“P”形空肠间置代胃术（mPJIP）组74例。比较两组患者的手术时间、手术并发症例数及死亡例数、术后营养学指标和生活质量的变化。结果：改良“P”形空肠间置代胃术组和P型空肠襻食管空肠Roux—en—Y吻合术组的手术时间分别为（3．6±0．2）h和（3．3±0．1）h，差异有统计学意义（P〈0．05）；死亡例数分别为2例（2．8％）和1例（1．4％），差异具有统计学意义。在体重变化、总蛋白变化、预后营养指数上mPJIP组显著优于PRY组，差异有统计学意义。在Roux潴留综合征（rouxstasissyndrome，RSS）发生数（率）上，mPJIP组显著优于PRY组，P〈0．01，差异有统计学意义；PRY组及mPJIP组术后反流性食管炎发生数和Cuschieri分级比较，差异无统计学意义（P〉0．05）。结论：改良“P”形空肠间置代胃术（mPJIP）可减少全胃切除术后并发症的发生率、死亡率，有效地防止反流性食管炎的发生，提高患者生活质量，是一种胃癌全胃切除术较为合理的消化道重建方法，具有很好的临床应用价值。

Two kinds of gastric cancer after total gastrectomy comparison of surgical reconstruction of digestive tract

Objective： To investigate the P-type jejunal loop esophagus jejunum Roux-en-Y anastomosis and improve the ＂P＂-shaped jejunal on behalf of the gastric surgery （mPJIP） of two different surgical reconstruction of digestive tract of clinical efficacy, and postoperative two kinds of surgical results for statistical analysis. Methods： The gastric cancer patients with total gastrectomy total of 146 cases were randomly divided into two groups： P-type jejunal loop esophagus jejunum Roux-en-Y anastomosis （PRY） group of 72 patients and improve the ＂P＂-shaped jejunal on behalf of the gastric surgery （mPJIP） group of 74 cases. Comparison of two groups of patients with operative time, surgical complications, the number of cases and death cases of the number of indicators of change in postoperative nutrition postoperative quality of life changes. Results： Improved ＂P＂-shaped jejunal on behalf of the gastric surgery group and the P-type jejunal loop esophagus jejunum Roux-en-Y anastomosis group operative time （h）, respectively （3.6±0.2） and （3.3±0.1）, P〈0.05; died a few cases were two cases （2.8%） and 1 case （1.4%）, the difference was significant. Changes in weight, total protein changes in the mPJIP prognostic nutritional index was significantly better than the PRY group, the difference was statistically significant. In the Roux retention syndrome （roux stasis syndrome, RSS） with a few （rate%） on, mPJIP group was significantly better than the PRY group, P〈0.01, the difference was statistically significant; PRY group and mPJIP postoperative reflux esophagitis occurrence number and Cuschieri classification comparison, the difference was not statistically significant （P〉0.05）. Conclusion： The modified ＂ P＂-shaped jejunal on behalf of the gasiric surgery （mPJIP） can reduce the total gastrectomy the incidence of postoperative complications, mortality, effectively prevent reflux esophagitis incidence and improve patient quality of life, it is more reasonable reconstruction of the digestive tract for the total gastrectomy of gastric cancer, with a good clinical value.