目的：探讨全胃切除术后食管空肠重建术和三腔代胃重建术对患者营养指标、消化道症状及生活质量的影响。方法选取2005年2月至2015年2月广元市第一人民医院普外科收治的180例行全胃切除术的患者作为研究对象，依据随机数字表法分为观察组（82例）和对照组（98例）。观察组采用三腔代胃重建术进行治疗，对照组采用食管空肠重建术进行治疗，并对其术后2个月的血浆营养参数等营养指标；代胃肠管储存和排空能力、食管下段的胆酸量和 pH值等消化道症状及进食量、体质量等生活质量进行测定并分析。结果观察组患者的营养状况明显优于对照组，其血红蛋白、白蛋白和总蛋白水平的增加幅度均显著高于对照组[（1．6±0．2） g／L比（1．1±0．3） g／L，（4．7±0．9） g／L 比（4．0±0．6） g／L，（7．0±2．4） g／L比（5．8±1．6） g／L]，差异有统计学意义（P＜0．01）；观察组胃肠症状评估量表评分及倾倒症状、反流性食管炎发生率显著低于对照组[（3．0±0．8）分比（4．0±1．1）分，1．2％（1／82）比12．2％（12／98），14．6％（12／82）比28．6％（28／98）]，食管下段的 pH 值、钡剂排空时间、闲置肠管最大直径大于对照组[15．2±3．8比9．4±2．2，（27．3±8．7） min 比（7．1±1．3） min，（4．6±1．0） cm比（3．3±0．6） cm]，差异有统计学意义（P＜0．01）。观察组术后体质量、每日进食量显著高于对照组[（54．2±3．1） kg比（52．0±2．9） kg，（168±29） g比（129±39） g]，每日进餐次数显著低于对照组[（3．6±0．7）次比（4．8±0．8）次]，差异有统计学意义（P＜0．01）。结论全胃切除术后采用三腔代胃重建术具有简单、省时、易行的优势，可明显改善患者术后的营养指标、消化道症状和生活质量，值得在临床上推广应用。%Objective To study the influence of esophagus jejunum reconstruction and three-cavity gastric reconstruction on the nutrition index and quality of life of patients with total gastrectomy .Methods Total of 180 patients who underwent total gastrectomy in Guangyuan City First People′s Hospital from Feb.2005 to Feb. 2015 were included in the study and divided into observation group(82 cases) and control group(98 cases) according to random number table method.The observation group adopted the three-cavity gastric reconstruction treatment,and the control group received esophagus jejunum reconstruction therapy,and after two months,the plasma nutrition parameters,gastric esophageal tube storage and emptying capacity,the digestive tract symptom such as the amount of bile acid and pH value of lower esophageal segment,body weight and food intake were measured and analyzed.Results Nutritional status of the observation group was better than the control group:the hemoglobin,albumin and total protein levels increase were significantly higher than those of the control group [(1.6 ±0.2) g/L vs (1.1 ±0.3) g/L,(4.7 ±0.9) g/L vs (4.0 ±0.6) g/L,(7.0 ±2.4) g/L vs (5.8 ± 1.6) g/L]the differences were statistically significant(P <0.01);Gastrointestinal Symptom Rating Scale score,incidence of dumping symptoms,reflux esophagitis of the observation group were lower than the control group[(3.0 ±0.8) scores vs (4.0 ±1.1) scores,1.2%(1/82) vs 12.2%(12/98),14.6%(12/82) vs28.6% (28/98)],pH value at lower esophagus segment,barium emptying time,intestinal idle maximum diameter were greater than the control group [ ( 15.2 ±3.8 ) vs ( 9.4 ±2.2 ) , ( 27.3 ±8.7 ) min vs ( 7.1 ± 1.3) min,(4.6 ±1.0) cm vs (3.3 ±0.6) cm],the differences were statistically significant(P<0.01).The body weight,daily food consumption of the observation group were greater than the control group[(54.2 ±3.1) kg vs (52.0 ±2.9) kg,(168 ±29) g vs (129 ±39) g],the number of meals per day was less than the control group[(3.6 ±0.7) times vs (4.8 ±0.8) times],the difference was statistically significant(P <0.01). Conclusion After total gastrectomy,three-cavity gastric reconstruction has the advantages of simple ,time-sav-ing and easy,which can significantly improve the postoperative nutritional index,gastrointestinal symptoms and quality of life of the patients,thus is worthy of popularization and application in clinical.
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