全胃切除术后三种消化道重建方式预防反流性食管炎的效果比较

目的评估全胃切除术后三种消化道重建方式预防反流性食管炎的效果。方法统计分析2002-2007年行全胃切除无瘤生存1年以上的96例胃癌患者，分别采用袢式空肠代胃＋Braun吻合（Braun）、单纯Roux—en—Y吻合（RY）和Roux—eli—Y吻合＋P形代胃（RYP）三种方式重建消化道，对这些患者资料进行回顾性分析，以术后的消化道症状和营养状况作为评价依据。结果Braun组存在严重的食管反流，RY和RYP重建则有较强的抗反流作用，RYP组饮食限制少、进餐早期饱足感发生少；术后半年时无瘤生存患者的营养状况三组无差异，而1年以后体重恢复和血浆总蛋白水平RY和硝母两组优于Braun组。结论Braun吻合术后食管反流严重、营养状况较差；而RY及在此基础上的P形代胃术效果良好，是比较合适的重建术式，建议对预期术后生存期超过1年以上患者，采用P形代胃术。

Effectiveness comparison of three alimentary tract reconstruction techniques on the prevention of reflux esophagitis after total gastrectomy

Objective:To evaluate the effect of three methods alimentary tract reconstruction on the preven-tion of reflux esophagitis after total gastrectomy.Methods: We retrospectively analyzed the clinical data of 96 patients with gastric cancer who underwent alimentary tract reconstruction after total gastrectomy from 2002 to 2007,and compared the digestive symptoms and nutritional status of patients with different recon-struction techniques.The alimentary tract reconstruction techniques included Braun anastomosis,Roux-en-Y(RY)and Roux-en-Y with P-pouch anastomosis(RYP).Results: The anti-reflux effect of RY and RYP groups were better than Braun group,dietary restriction and postprandial satiety rarely occurred in RYP group,the nutritional status at 6 months after operation were no difference among three groups,and the weight restoration and the level of serum total protein level of RY and RYP groups were better Braun group.Conclusion: The curative effect of RY and RYP reconstruction techniques were better than Braun technique.