切换至 "中华医学电子期刊资源库"

中华普外科手术学杂志(电子版) ›› 2020, Vol. 14 ›› Issue (01) : 31 -34. doi: 10.3877/cma.j.issn.1674-3946.2020.01.011

所属专题: 文献

论著

早期近端胃癌术后不同消化道重建方式对营养状况及胆囊结石的影响
嵇晋1, 汪刘华2, 汤东2, 王伟2, 金芝祥3, 王杰1, 梁家奎1, 刘佳文3, 马成民3, 王道荣2,()   
  1. 1. 225001 扬州大学临床医学院
    2. 225001 江苏省苏北人民医院普外科研究所
    3. 116044 大连医学大学研究生院
  • 收稿日期:2019-05-27 出版日期:2020-02-26
  • 通信作者: 王道荣

Impact of different kinds of digestive tract reconstruction on nutritional status and cholecystolithiasis of patients with early gastric cancer underwent proximal gastrectomy

Jin Ji1, Liuhua Wang2, Dong Tang2, Wei Wang2, Zhixiang Jin3, Jie Wang1, Jiakui Liang1, Jiawen Liu3, Chengmin Ma3, Daorong Wang2,()   

  1. 1. Clinical Medical College, Yangzhou University, Jiangsu 225001, China
    2. Institute of General Surgery, Subei people’s hospital, Jiangsu 225001, China
    3. Graduate school of dalian medical university, Liaoning 116044, China
  • Received:2019-05-27 Published:2020-02-26
  • Corresponding author: Daorong Wang
  • About author:
    Corresponding author: Wang Daorong Email:
  • Supported by:
    333 Project for High-level Talents Cultivation of Jiangsu Province(No.BRA2017153)
引用本文:

嵇晋, 汪刘华, 汤东, 王伟, 金芝祥, 王杰, 梁家奎, 刘佳文, 马成民, 王道荣. 早期近端胃癌术后不同消化道重建方式对营养状况及胆囊结石的影响[J/OL]. 中华普外科手术学杂志(电子版), 2020, 14(01): 31-34.

Jin Ji, Liuhua Wang, Dong Tang, Wei Wang, Zhixiang Jin, Jie Wang, Jiakui Liang, Jiawen Liu, Chengmin Ma, Daorong Wang. Impact of different kinds of digestive tract reconstruction on nutritional status and cholecystolithiasis of patients with early gastric cancer underwent proximal gastrectomy[J/OL]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2020, 14(01): 31-34.

目的

探讨早期近端胃癌术后不同消化道重建方式对术后营养状况及胆囊结石的影响。

方法

回顾性分析2013年1月至2016年6月82例行近端胃切除患者资料,其中40例行传统食管残胃吻合术(EG组) ,19例行单通道空肠间置术(JI组) ,23例行双通道空肠间置术(DTR组),采用SPSS24.0软件对数据进行分析,围术期指标以均数±标准差表示,三组间比较采用单因素方差分析,两两比较采用t检验;术后并发症及胆囊结石发生率比较采用χ2检验。P<0.05差异有统计学意义。

结果

DTR组及JI组较EG组手术时间更长(P<0.05);术后发生并发症反流性食管炎DTR组与JI组发生率低于EG组(P<0.05);三组患者术后1、3、6个月营养状况比较(总蛋白、白蛋白和血红蛋白),DTR组和JI组均优于EG组(P<0.05);三组患者术后2年累计发生胆囊结石比较,DTR组与JI组发生率低于EG组(P<0.05)。

结论

早期近端胃癌采用空肠间置吻合术可明显降低术后反流性食管炎发生,并且能够改善患者术后营养状况,降低胆囊结石的发生率,可提升患者生存质量,值得临床推广。

Objective

To investigate the impact of different kinds of digestive tract reconstruction on nutritional status and cholecystolithiasis of patients with early gastric cancer underwent proximal gastrectomy.

Methods

From January 2013 to June 2016, clinical data of 82 patients underwent proximal gastrectomy were retrospectively analyzed, including 40 cases of traditional esophageal residual gastrostomosis (EG group), 19 cases of single-channel jejunal interposition(SJI group), 23 cases of dual-channel jejunal interposition(DJI group). Statistical analysis were performed by using SPSS24.0 software. Measurement data, such as perioperative indicators were expressed as (±s), and were examined by one-way variance analysis and t test. Count data such as postoperative complications and the incidence of gallbladder stones were examined by chi square test. A P value <0.05 was considered as statistically significant difference.

Results

Compared with EG group, there were longer operation time in SJI group and DJI group (P<0.05). The incidence of reflux esophagitis in DJI group and SJI group were significantl lower than that in EG group (P<0.05). In terms of nutritional status (total protein, albumin and hemoglobin) at 1, 3 and 6 months after operation in DJI group and SJI group were better than those in EG group respectively. Cumulative incidence of gallstones 2 years after operation in DJI group and SJI group were significantly lower than that in EG.

Conclusion

For patients with early gastric cancer undergo proximal gastrectomy and jejunal interposition could significantly reduce the incidences of reflux esophagitis, could effectively improve the nutritional status and could reduce the incidences gallstones, which could improve the quality of life and is worth of clinical promotion.

表1 82例行近端胃切除的患者不同吻合方式三组患者基本资料比较[(±s),例]
表2 82例行近端胃切除的患者不同吻合方式三组患者围术期资料比较(±s)
表3 82例行近端胃切除的患者不同吻合方式三组患者术后并发症比较(例)
表4 82例行近端胃切除的患者不同吻合方式三组患者手术前后总蛋白状况[g/L, (±s)]
表5 82例行近端胃切除的患者不同吻合方式三组患者手术前后白蛋白状况[g/L,(±s)]
表6 82例行近端胃切除的患者不同吻合方式三组患者手术前后血红蛋白状况[g/L,(±s)]
表7 82例行近端胃切除的患者不同吻合方式三组术后累计胆囊结石发生情况[例(%)]
[1]
Kanat O, O’Neil B, Shahda S.Targeted therapy for advanced gastric cancer:a review of current status and future prospects[J].World J Gastrointest Oncol,2015,7(12):401-410.
[2]
Sugano K.Screening of gastric cancer in Asia[J].Best Pract Res Clin Gastroenterol,2015,29(6):895-905.
[3]
Saito T, Kurokawa Y, Takiguchi S,et al.Current status of function-preserving surgery for gastric cancer[J].World J Gastroenterol,2014,20(46):17297-17304.
[4]
Allum WH.Optimal surgery for gastric cancer:is more always better?[J].Recent Results Cancer Res,2012,196:215-227.
[5]
胡祥.不断提高胃癌手术消化道重建规范化水平[J/CD].中华普外科手术学杂志:电子版,2014,8(4):281-284.
[6]
胡建昆,赵林勇.腹腔镜胃癌根治术的难点与争议[J/CD].中华普外科手术学杂志(电子版),2018,12(2) :91-94.
[7]
胡祥.胃癌腹主动脉周围淋巴结廓清的变迁及现状[J/CD].中华普外科手术学杂志(电子版),2017,11(6):451-456.
[8]
何裕隆.腹腔镜下胃癌根治联合结肠部分切除的实践与评价[J/CD].中华普外科手术学杂志(电子版),2017,11 (6):461-463.
[9]
胡祥.第5版日本《胃癌治疗指南》拔萃[J].中国实用外科杂志,2018,38(4):396-406.
[10]
胡兵,张维汉,吴春成,等.远端胃癌切除术不同消化道重建方式术后恢复指标和术后一年上消化道内镜评估结果的比较[J].中华胃肠外科杂志,2016,19(2):216-220.
[11]
贾宝新.胃癌术后胆囊结石的原因及治疗分析[J].临床医学,2014,34(6):78-79.
[12]
张贤坤,刘宏斌,韩晓鹏,等.两种重建方式在腹腔镜近端胃癌切除术中的对比研究[J].中国普通外科杂志,2015,24(8):1191-1194.
[13]
Jung DH, Ahn SH, Park DJ,et al.Proximal Gastrectomy for Gastric Cancer[J].J Gastric Cancer,2015,15(2):77-86.
[14]
曹廷宝,韩晓鹏,张贤坤,等.腹腔镜功能性单通道襻式间置空肠吻合术[J].中华消化外科杂志,2014,13(2): 98-101.
[15]
吴宸,姜淮芜,彭方兴,等.胃癌手术不同消化道重建方式对患者术后胆囊收缩功能的影响[J].海南医学,2016,27(3):381-383.
[16]
李茂然,朱纯超,赵刚,等.功能性保护腹腔镜辅助根治性近端胃切除术在早期胃癌治疗中的应用[J].中华胃肠外科杂志,2016,19(2):190-194.
[17]
Ding X, Yan F, Liang H,et al.Functional jejunal interposition,a reconstruction procedure,promotes functional outcomes after total gastrectomy[J].BMC Surg,2015,15:43.
[18]
Zhao P, Xiao SM, Tang LC,et al.Proximal gastrectomy with jejunal interposition and TGRY anastomosis for proximal gastric cancer[J].World J Gastroenterol,2014,20(25): 8268-8273.
[19]
邓先锐,徐国宏,岳文杰,等.保留胃窦空肠间置双通道手术与传统消化道重建对胃食管结合部癌患者生存质量及预后的影响对比[J].河北医学,2015,21(8):1423-1426.
[20]
Chen Y, Li Y.Related factors of postoperative gallstone formation after distal gastrectomy: A meta-analysis[J].Indian J Cancer,2017,54(1):43-46.
[21]
Liang TJ, Liu SI, Chen YC,et al.Analysis of gallstone disease after gastric cancer surgery[J].Gastric Cancer,2017,20(5):895-903.
[22]
张继红,杨可桢,韩本立.胆囊结石形成的动力学机制[J].中华普通外科杂志,2001,16(7):424-426.
[23]
耿嘉蔚,范红,曹慧娟,等.上消化道运动障碍与胃食管反流病相关性研究[J].临床消化病杂志,2009, 21(3):169-171.
[1] 安杰, 牛云峰, 刘伟. LINC00520 通过miR-519b-3p/HIF1A 轴促进胃癌的侵袭转移[J/OL]. 中华普通外科学文献(电子版), 2024, 18(06): 430-436.
[2] 李国新, 陈新华. 全腹腔镜下全胃切除术食管空肠吻合的临床研究进展[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 1-4.
[3] 陈方鹏, 杨大伟, 金从稳. 腹腔镜近端胃癌切除术联合改良食管胃吻合术重建His角对术后反流性食管炎的效果研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 15-18.
[4] 许杰, 李亚俊, 韩军伟. 两种入路下腹腔镜根治性全胃切除术治疗超重胃癌的效果比较[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 19-22.
[5] 李刘庆, 陈小翔, 吕成余. 全腹腔镜与腹腔镜辅助远端胃癌根治术治疗进展期胃癌的近中期随访比较[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 23-26.
[6] 刘世君, 马杰, 师鲁静. 胃癌完整系膜切除术+标准D2根治术治疗进展期胃癌的近中期随访研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 27-30.
[7] 任佳, 马胜辉, 王馨, 石秀霞, 蔡淑云. 腹腔镜全胃切除、间置空肠代胃术的临床观察[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 31-34.
[8] 王露, 周丽君. 全腹腔镜下远端胃大部切除不同吻合方式对胃癌患者胃功能恢复、并发症发生率的影响[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 92-95.
[9] 陈浩, 王萌. 胃印戒细胞癌的临床病理特征及治疗选择的研究进展[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 108-111.
[10] 梁孟杰, 朱欢欢, 王行舟, 江航, 艾世超, 孙锋, 宋鹏, 王萌, 刘颂, 夏雪峰, 杜峻峰, 傅双, 陆晓峰, 沈晓菲, 管文贤. 联合免疫治疗的胃癌转化治疗患者预后及术后并发症分析[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 619-623.
[11] 刘海旺, 施海, 尚利峰. 不同吻合器在腹腔镜远端胃癌根治术Roux-en-Y式吻合中的应用对比[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 643-646.
[12] 许杰, 李亚俊, 冯义文. SOX新辅助化疗后腹腔镜胃癌D2根治术与常规根治术治疗进展期胃癌的近期随访比较[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 647-650.
[13] 白浪, 张雪玉, 白铁成, 贺爱军. 腹腔镜近端胃切除术中圆锥形重叠吻合成形术对Siewert Ⅱ型AEG患者胃食管反流、营养状态的影响研究[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 679-682.
[14] 贺斌, 马晋峰. 胃癌脾门淋巴结转移危险因素[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 694-699.
[15] 张立俊, 孙存杰, 胡春峰, 孟冲, 张辉. MSCT、DCE-MRI 评估术前胃癌TNM 分期的准确性研究[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(06): 519-523.
阅读次数
全文


摘要