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不同术式远端胃癌根治术的临床疗效比较
向荣超,邓志纲,向春华,智星,鲍峰,沈俊
0
(绵阳市中心医院普外科;川北医学院第二附属医院普外科)
摘要:
【摘要】目的 探讨Billroth Ⅰ式、Billroth Ⅱ式及RouxenY吻合术对行远端胃癌根治术患者围术期指标、胃肠功能恢复及术后1年并发症的影响。方法 将2015年2月~2018年2月于绵阳市中心医院胃肠外科行远端胃癌根治术的80例患者根据消化道重建方式不同分为A组(Billroth Ⅰ式吻合术,n=22)、B组(Billroth Ⅱ式吻合术,n=30)、C组(RouxenY吻合术,n=28)。记录并比较3组围术期指标及胃肠功能恢复情况,术后随访1年,采用Chewwun Wu特殊症状量表评价患者术后6个月的营养状况,并比较两组术后1年并发症发生率。结果 3组手术时间及术中出血量比较均为C组>B组>A组,差异有统计学意义(P<005);A组与B组术后排气时间、术后拔管时间、经口进食时间及住院时间比较差异无统计学意义(P>005);C组术后排气时间、术后拔管时间、经口进食时间均晚于A组与B组,且住院时间长于A组与B组,差异有统计学意义(P<005);C组反流烧心感症状评分高于A组与B组,差异有统计学意义(P<005);C组残胃炎、胆汁反流、反流性食管炎、倾倒综合征并发症发生率低于A组与B组,差异有统计学意义(P<005);B组吻合口炎症、吻合溃疡、残胃炎、胆汁反流、反流性食管炎、倾倒综合征各并发症发生率均高于A组,差异有统计学意义(P<005)。结论 远端胃癌根治术后选择Billroth Ⅰ式吻合术操作更加简单,术后胃肠功能恢复较好,并发症少,更符合人的正常生理通道;Billroth Ⅱ式吻合术操作虽较RouxenY吻合术更为简便,但并发症多;RouxenY吻合术手术操作复杂,术后胃肠功能恢复较慢,但其抗反流效果及安全性更好,并发生少。
关键词:  Billroth Ⅰ  Billroth Ⅱ  Roux en Y  远端胃癌根治术  胃肠功能恢复
DOI:
基金项目:四川省科技支撑计划项目(2015SZ0077)
Comparison of clinical efficacy of different surgical approaches for distal radical gastrectomy
XIANG Rongchao,DENG Zhigang,XIANG Chunhua,ZHI Xing,BAO Feng,SHEN Jun
(Department of General Surgery, Mianyang Central Hospital;Department of General Surgery, The Second Affiliated Hospital of North Sichuan Medical College)
Abstract:
【Abstract】 Objective To explore the effects of Billroth I, Billroth II and RouxenY anastomosis on perioperative indexes, gastrointestinal function recovery and complications at 1 year after operation in patients with distal radical gastrectomy. Methods 80 patients with distal radical gastrectomy from February 2015 to February 2018 in Mianyang Central Hospital were divided into group A (n=22, Billroth I anastomosis), group B (n=30, Billroth II anastomosis) AND group C (n=28, RouxenY anastomosis). The perioperative indexes and gastrointestinal recovery were recorded and compared between the two groups. After 1 years of followup, Chewwun Wu special symptom scale was used to evaluate the nutritional status of patients at 6 months after operation, and the incidence rate of complications at 1 years after operation was compared between the two groups. Results The operation time and bleeding volume of the 3 groups were C group>B group>A group (P<005). There was no significant difference in postoperative exhaust time, postoperative extubation time, oral intake time and hospital stay between A group and B group (P>005). The postoperative exhaust time, postoperative extubation time and oral intake time in C group were all later than those in A groups and B groups. The hospital stay was longer than those in A group and B group (P<005). The backflow heartburn symptom score in C group were significantly higher than those in A group and B group (P<005). The incidence rate of complications such as anastomosis inflammation, anastomotic ulcer, residual gastritis, bile reflux, reflux esophagitis and dumping syndrome was significantly higher in B group (P<005). The incidence rates of complications of anastomotic inflammation, anastomotic ulcer, residual gastritis, bile reflux, reflux esophagitis and dumping syndrome in group B were significantly higher than those in A group (P<005). Conclusion Billroth I anastomosis after distal radical gastrectomy has simple operations, good recovery of postoperative gastrointestinal function and few complications, and it is more in line with normal human physiological pathways. Billroth II anastomosis has simpler operations but more complications compared with RouxenY anastomosis. RouxenY anastomosis has complicated operations and slow recovery of postoperative gastrointestinal function, but it has good antireflux effects and safety, and few complications.
Key words:  Billroth I  Billroth II  Roux en Y  Distal radical gastrectomy  Gastrointestinal function recovery

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