目的

观察腹腔镜全胃切除、间置空肠代胃术对胃癌患者术后营养状况以及胆囊排空的影响。

方法

回顾性分析2016 年1 月至2021 年3 月116 例腹腔镜全胃切除术患者临床资料，依据消化道重建方式分为对照组（n=58 例，以Roux-en-Y 吻合术重建消化道）和研究组（n=58 例，以间置空肠代胃术重建消化道）。用SPSS 25.0 软件分析数据。术中出血量、消化道重建时间、肠功能恢复时间和恢复进食时间等计量资料以（x ± s）描述，组内比较采用配对样本t检验，组间比较采用独立样本t 检验；并发症等计数资料以［例（%）］表示，行χ² 检验。P＜0.05为差异有统计学意义。

结果

两组患者术后1 个月血清白蛋白（ALB）、血红蛋白（HB）和总蛋白（TP）水平以及胆囊空腹容积（FV）、脂餐后胆囊残余容积（RV）和胆囊残余指数（RF）显著降低，胆囊排空容积（EV）和胆囊排空率（EF）显著升高（P＜0.05），且研究组FV、RV 和RF 显著低于对照组，血清ALB、HB、TP 水平以及EV、EF 显著高于对照组（P＜0.05）；研究组患者围手术期并发症和术后并发症发生率均显著低于对照组（P＜0.05）。

结论

腹腔镜全胃切除后间置空肠代胃术安全、可行，可提高患者营养状况、促进胆囊排空。

Objective

To observe the effects of laparoscopic total gastrectomy and interposition jejunal replacement on postoperative nutritional status and gallbladder empties in patients with gastric cancer.

Methods

The clinical data of 116 patients with laparoscopic total gastrectomy from January 2016 to March 2021 were retrospectively analyzed， and divided into the reference group （n=58 cases， digestive tract reconstruction by Roux-en-Y anastomosis） and the study group （n=58 cases， digestive tract reconstruction by interposition jejunum replacement） according to the method of digestive tract reconstruction.SPSS 25.0 software was used to analyze the data.Intraoperative blood loss， digestive tract reconstruction time， intestinal function recovery time and feeding recovery time were described as（x ± s）.Paired sample t test was used for intra-group comparison， and independent sample t test was used for inter-group comparison.The statistical data of complications were shown as［ cases （%）］ and χ² test was performed.P＜0.05 was considered statistically significant.

Results

Serum albumin （ALB）， hemoglobin （HB） and total protein （TP） levels， fasting gallbladder volume （FV）， residual gallbladder volume （RV） and residual gallbladder index （RF） after fat meal were significantly decreased in 2 groups 1 month after surgery， and gallbladder emptier volume （EV） and gallbladder emptier rate （EF） were significantly increased （P＜0.05）.FV， RV and RF in study group were significantly lower than those in reference group， serum ALB， HB， TP， EV and EF were significantly higher than those in reference group （P＜0.05）.The incidence of perioperative and postoperative complications in the study group was significantly lower than that in the reference group （P＜0.05）.

Conclusion

It is safe and feasible to replace the stomach with jejunum after laparoscopic total gastrectomy， which can improve the nutritional status of patients and promote gallbladder empelation.