Chen Ying-bo, Li Yuan-fang, Feng Xing-yu, Zhou Zhi-wei, Zhan You-qing, Li Wei, Sun Xiao-wei, Xu Da-zhi, Guan Yuan-xiang
Department of Gastric and Pancreatic Surgery, Sun Yat-sen University, Guangzhou 510060, China.
Zhonghua Zhong Liu Za Zhi. 2011 Feb;33(2):126-9.
To evaluate the influence of two different types of digestive tract reconstruction on the life quality, nutritional status and tolerance to adjuvant chemotherapy after total gastrectomy in patients with gastric carcinoma.
The clinical data of a total of 107 patients treated in our department from January 2005 to december 2008 were analyzed retrospectively. Among them, 49 patients underwent digestive tract reconstruction with functional jejunal interposition (FJI group) and 58 patients underwent Roux en-Y jejunal P-type anastomosis (PR group) after total gastrectomy. 79 of 107 (73.8%) patients received postoperative adjuvant chemotherapy with XELOX regimen. The digestive complications and tolerance to chemotherapy were assessed respectively.
Neither severe complications nor surgery-related or chemotherapy-related death were observed among the 107 patients. There were statistical differences in the incidence rate of emaciation, dumping syndrome and retention syndrome between the FJI and PR groups (P < 0.05), but no significant statistical difference in incidence rate of reflux esophagitis (P > 0.05). 28 of 40 (70.0%) patients in the FJI group completed all six cycles of chemotherapy, while 12 (30.0%) patients interrupted the treatment due to chemotherapy-related toxicity. 39 patients in the PR group received chemotherapy, 19 (48.7%) of them completed 6 cycles of chemotherapy but 20 (51.3%) patients interrupted. There was a significant difference in the incidence rate of grade III/IV chemotherapeutic toxicity and completion rate of chemotherapy (P < 0.05).
Both functional jejunal interposition and Roux-Y operation are reasonable and safe procedures of digestive tract reconstruction. The incidence rates of emaciation, dumping syndrome and retention syndrome are lower in the patients with FJI, showing a better tolerance to adjuvant chemotherapy than Roux en-Y jejunal p type anastomosis.
评估两种不同类型的消化道重建对胃癌患者全胃切除术后生活质量、营养状况及辅助化疗耐受性的影响。
回顾性分析2005年1月至2008年12月在我科接受治疗的107例患者的临床资料。其中，49例行功能性空肠间置消化道重建（FJI组），58例行全胃切除术后Roux-en-Y空肠P型吻合术（PR组）。107例患者中有79例（73.8%）术后接受XELOX方案辅助化疗。分别评估消化道并发症及化疗耐受性。
107例患者均未观察到严重并发症及手术相关或化疗相关死亡。FJI组与PR组在消瘦、倾倒综合征及潴留综合征发生率方面存在统计学差异（P<0.05），但反流性食管炎发生率无显著统计学差异（P>0.05）。FJI组40例患者中有28例（70.0%）完成了全部6个周期化疗，12例（30.0%）患者因化疗相关毒性中断治疗。PR组39例患者接受化疗，其中19例（48.7%）完成6个周期化疗，20例（51.3%）患者中断治疗。Ⅲ/Ⅳ级化疗毒性发生率及化疗完成率存在显著差异（P<0.05）。
功能性空肠间置术和Roux-Y手术均为合理、安全的消化道重建术式。FJI患者消瘦、倾倒综合征及潴留综合征发生率较低，对辅助化疗的耐受性优于Roux-en-Y空肠P型吻合术。
