胃癌全胃切除术后间置重建与 Roux-en-Y 比较的长期术后评估：前瞻性随机对照试验。

Postoperative long-term evaluation of interposition reconstruction compared with Roux-en-Y after total gastrectomy in gastric cancer: prospective randomized controlled trial.

机构信息

Office of the Japanese Society for Gastro-surgical Pathophysiology Groups, Department of Digestive Surgery, Kagoshima University School of Medicine, 8-35-1 Sakuragaoka, Kagoshima 890-8520, Japan.

出版信息

Am J Surg. 2011 Sep;202(3):247-53. doi: 10.1016/j.amjsurg.2011.04.004.

DOI:10.1016/j.amjsurg.2011.04.004

PMID:21871978

Abstract

BACKGROUND

The postoperative clinical superiority of the interposition of jejunum reconstruction (INT) to Roux-en-Y reconstruction (RY) after total gastrectomy has not been clarified. Postoperative quality of life (QOL) was evaluated between the 2 methods by a multi-institutional prospective randomized trial.

METHODS

A total of 103 patients with gastric cancer were prospectively randomly divided into groups for RY (n = 51) or INT reconstruction (n = 52) after total gastrectomy. They were stratified by sex, age, institute, histology, and degree of lymph node dissection. Postoperatively, body mass index (BMI) and nutritional conditions were measured serially, and QOL and postoperative squalor scores were evaluated at 3, 12, and 60 months and compared between the 2 groups.

RESULTS

After removing patients who did not complete the follow-up survey or censured cases, 24 patients in the RY group and 18 patients in the INT group were clinically available and their postoperative status was assessed. QOL scores were increased and complication scores were improved in the postoperative periods (P < .01). Postoperative BMI significantly deteriorated compared with preoperative BMI in each group. The postoperative QOL and complication scores at 60 months after surgery were significantly better than those at 3 months after surgery in each group (P < .01). However, there was no significant difference of QOL scores and postoperative complication scores between the 2 reconstruction groups. The nutritional condition in the INT group was nearly the same as that in the RY group.

CONCLUSIONS

Although our patient sample was small and patients who did not complete the follow-up survey were present, we could not identify any clinical difference between INT and RY after total gastrectomy 60 months after surgery. The safer and simpler RY method may be a more suitable reconstruction method than INT after total gastrectomy.

摘要

背景

全胃切除术后空肠间置重建（INT）与 Roux-en-Y 重建（RY）的术后临床优势尚未明确。本多机构前瞻性随机试验通过比较两种方法评估术后生活质量（QOL）。

方法

前瞻性随机将 103 例胃癌患者分为 RY 组（n = 51）或 INT 重建组（n = 52），行全胃切除术后。按性别、年龄、机构、组织学和淋巴结清扫程度分层。术后连续测量体重指数（BMI）和营养状况，并在 3、12 和 60 个月时评估 QOL 和术后不适评分，并比较两组之间的评分。

结果

在剔除未完成随访调查或失访的患者后，RY 组 24 例和 INT 组 18 例患者的临床资料可用于评估术后情况。术后 QOL 评分增加，并发症评分改善（P <.01）。每组术后 BMI 均较术前明显下降。与术后 3 个月相比，两组术后 60 个月 QOL 和并发症评分均显著改善（P <.01）。但两组重建术后 QOL 评分和术后并发症评分无显著差异。INT 组的营养状况与 RY 组相近。