Miyoshi K, Fuchimoto S, Ohsaki T, Sakata T, Ohtsuka S, Takakura N
Department of Surgery, Fukuyama National Hospital, Japan.
Gastric Cancer. 2001;4(3):156-61. doi: 10.1007/pl00011739.
Jejunal pouch reconstruction after total gastrectomy has been demonstrated to ameliorate postgastrectomy symptoms, with the process of adaptation taking several months. In contrast to the short-term effects of pouch reconstruction, there are few reports about the long-term consequences (more than 2 years after surgery).
In this study, 22 patients with jejunal pouch (PRY group) and 12 patients without jejunal pouch (RY group) who survived for more than 2 years without any recurrence and were available for follow-up were compared. Patients in the two groups were compared 2 years after surgery in terms of postgastrectomy symptoms, and improvements in body weight and nutritional parameters.
Eating capacity at a single meal compared with that in the pre-illness state was significantly better in the PRY group than in the RY group. The total score on the gastrointestinal symptom rating scale (GSRS) in the PRY group was less than that in the RY group (3.17 vs 5.25). The GSRS score for reflux syndrome in the PRY group was significantly better than that in the RY group. Assessment according to Cuschieri's gradings revealed that the total score in the PRY group was lower than that in the RY group (2.73 vs 5.92). Among the various symptoms examined, the incidence of dietary restriction and that of heartburn were significantly lower in the PRY group.
We conclude that, 2 years after total gastrectomy, the pouch reconstruction had alleviated postgastrectomy symptoms to a greater extent than simple Roux-en-Y reconstruction, but the effectiveness could be improved. The long-term effects of pouch reconstruction should be examined more precisely with an adequate and valid scoring system for determining quality of life.
全胃切除术后行空肠袋重建已被证明可改善胃切除术后症状，适应过程需数月时间。与空肠袋重建的短期效果相比，关于长期后果（手术后超过2年）的报道较少。
本研究比较了22例空肠袋患者（PRY组）和12例未做空肠袋患者（RY组），这些患者均存活超过2年且无任何复发，可供随访。两组患者在术后2年时比较胃切除术后症状、体重改善情况及营养参数。
与患病前状态相比，PRY组单次进餐的进食能力明显优于RY组。PRY组胃肠道症状评分量表（GSRS）总分低于RY组（3.17对5.25）。PRY组反流综合征的GSRS评分明显优于RY组。根据库斯基里分级评估显示，PRY组总分低于RY组（2.73对5.92）。在检查的各种症状中，PRY组饮食限制和烧心的发生率明显较低。
我们得出结论，全胃切除术后2年，空肠袋重建比单纯Roux-en-Y重建在更大程度上缓解了胃切除术后症状，但效果仍可改善。应使用适当有效的生活质量评分系统更精确地研究空肠袋重建的长期效果。
