全胃切除术后两种消化道重建术式的前瞻性临床研究阶段报告

摘要

目的 比较全胃切除术后功能性间置空肠代胃术与Roux-en-Y术两种消化道重建方式的术后远期并发症及生活质量.方法 2012年3月至2013年2月间天津医科大学附属肿瘤医院前瞻性入组109例胃癌住院患者,在全胃切除及淋巴结清扫后,术中根据随机数字表法将患者分为R-Y组(采用Roux-en-Y重建术,57例)和FJI组(采用功能性间置空肠代胃重建术,52例),比较两组患者术后并发症、营养指标及生活质量.结果 术后1、3和6个月,F JI组R-S综合征发生率均明显低于R-Y组[13％(6/45)比37％(18/49),3％(1/30)比42％(14/33),5％(1/21)比48％(11/23),均P＜0.01],但在3个月时,FJI组反流和烧心症状的出现率则明显高于R-Y组[53％(16/30)比21％(7/33),P＜0.01;37％(11/30)比12％(4/33);P＜0.05].两组患者术后各项营养指标的差异均无统计学意义(均P＞0.05).核心问卷EORTC QLQ-C30 V3评分显示,两组患者在术后各个随访时间点总体健康状况评分的差异均无统计学意义(均P＞0.05),但胃癌补充问卷EORTC-QLQ-STO22评分显示,FJI组患者在术后1个月和3个月时,“进食”评分明显优于R-Y组,但在术后3个月时“反流”评分则明显劣于R-Y组(均P＜0.01).结论 功能性间置空肠代胃术保留了食物十二指肠通过和肠道神经传导的完整,是一种较为合理的消化道重建方式.%Objective To compare post-operative long-term complications and quality of life of two digestive reconstruction procedures after total gastrectomy.Methods A total of 109 gastric cancer patients in Tianjin Medical University Cancer Hospital from March 2012 to February 2013 were prospectively enrolled and randomly divided into functional jejunal interposition (FJI) group (52 cases) and Roux-en-Y (R-Y) group (57 cases).The post-operative complications,nutritional status,and the quality of life were compared between two groups.Results One,3 and 6 months after operation,the incidence of R-S syndrome in FJI group was lower as compared to R-Y group [13％(6/45) vs.37％ (18/49),3％(1/30) vs.42％(14/33),5％(1/21) vs.48％(11/23),all P＜0.01],while 3 months after operation,the incidence of reflux and heartburn in FJI group was higher [53％(16/30) vs.21％ (7/33),P＜0.01; 37％(11/30) vs.12％(4/33),P＜0.05].There were no significant differences in quality of life questionnaire QLQ-C30 between R-Y and FJI groups.QLQ-STO22 stomach module revealed in FJI group,the eating score was better,but reflux score was worse as compared to R-Y group 3 months after operation (all P＜0.01).Conclusions Functional jejunal interposition keeps intestinal continuity preserving and food duodenal passing,which is a reasonable digestive reconstruction procedure.