Nakane Y, Okumura S, Akehira K, Okamura S, Boku T, Okusa T, Tanaka K, Hioki K
2nd Department of Surgery, Kansai Medical University, Osaka, Japan.
Ann Surg. 1995 Jul;222(1):27-35. doi: 10.1097/00000658-199507000-00005.
The authors determined the optimum reconstruction procedure after total gastrectomy in terms of the quality of life of the patients.
Gastric replacement with various enteric reservoirs has been used to improve the postprandial symptoms and nutrition of patients after total gastrectomy. However, the effect of each is uncertain because no prospective randomized studies have been conducted.
A randomized controlled trial was conducted to compare the usefulness of the three reconstruction procedures of simple Roux-en-Y (RY; N = 10), pouch and Roux-en-Y (PR; N = 10), and pouch and interposition (PI; N = 10). In each subject, the postprandial symptoms, food intake in a single meal, body weight, serum nutritional parameters, and emptying time of the gastric substitute were evaluated.
The PR group showed significantly greater food intake in a single meal than the RY and PI groups, and greater weight recovery than the PI group. A gastric emptying test also revealed satisfactory retention capacity and emptying time of the gastric substitute in the PR group.
Pouch and Roux-en-Y reconstruction is the most useful of the three procedures for improving the postoperative quality of life. In patients with pouch and interposition reconstruction, the clinical assessment was quite poor, even though it is a physiologic route.
作者从患者生活质量的角度确定了全胃切除术后的最佳重建方法。
用各种肠贮袋替代胃已被用于改善全胃切除术后患者的餐后症状和营养状况。然而，由于尚未进行前瞻性随机研究，每种方法的效果尚不确定。
进行了一项随机对照试验，比较单纯Roux-en-Y（RY；n = 10）、贮袋与Roux-en-Y（PR；n = 10）以及贮袋与间置术（PI；n = 10）这三种重建方法的有效性。对每个受试者的餐后症状、单次进餐的食物摄入量、体重、血清营养参数以及胃替代物的排空时间进行了评估。
PR组单次进餐的食物摄入量显著高于RY组和PI组，体重恢复情况也优于PI组。胃排空试验还显示PR组胃替代物的潴留能力和排空时间令人满意。
在改善术后生活质量方面，贮袋与Roux-en-Y重建是这三种方法中最有效的。在采用贮袋与间置术重建的患者中，尽管这是一种符合生理的术式，但临床评估结果相当差。
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