胃癌远端胃大部切除术后两种消化道重建方式的配比分析

摘要

Objective:To investigate the advantages and disadvantages of two kinds of digestive tract reconstruc-tion methods for distal gastrectomy(DG):B -II +Braun and Roux -en -Y.Methods:Clinical and follow -up data of patients with gastric cancer who underwent B -II +Braun and Roux -en -Y in our hospital from January 2010 to January 2013 were analyzed retrospectively.Patients were divided into two groups according to reconstruction meth-ods,and selected by Gmatch method basing on gender,age,tumor size and tumor staging.The surgery related indexes (operation time,estimated blood loss,time of gas passing,postoperative hospital stay),recent and long -term compli-cations,gastroscopic results over one year after operation were compared between two groups.Results:There were no significant differences in the surgery related indexs,recent complications and postoperative survival rate between the two groups (P >0.05).As in the long -term complications,the incidence of heartburn /bile reflux,dumping syn-drome was significantly higher in B -II +Braun group (20.83%,16.67%)than Roux -en -Y group (4.17%, 4.17%)(P <0.05).Over one year after surgery,endoscopic examination results showed that the incidence of reflux gastritis,bile reflux and reflux esophagitisin in Roux -en -Y group (31.25%,18.75%,9.38%)were significantly lower than that in B -II +Braun group(72.22%,61.11%,36.11%)(P <0.05).There was no significant differ-ence in residual food beteeen two groups(P >0.05).Conclusion:Compared with B -II +Braun,Roux -en -Y has obvious advantages in anti reflux in patients receiving DG,while there was no obvious disadvantage in the safety of op-eration and survival rate after surgery between the two groups.As a result,B -II +Braun should be replaced by Roux-en -Y,and the later is worth promoting in clinical practice.%目的：探讨胃癌远端胃大部切除后行 B －II ＋Braun 或 Roux －en －Y 两种消化道重建方式的优缺点。方法：回顾性分析我院2010年1月至2013年1月间接受远端胃大部切除并行上述消化道重建的胃癌患者临床及随访资料，据消化道重建方式分为 B －II ＋Braun 和 Roux －en －Y 两组，按性别、年龄、肿瘤大小、肿瘤分期进行配比，比较两组患者手术相关指标（手术时间、术中出血量、术后首次排气时间、术后住院时间）、术后近、远期并发症、术后1年以上胃镜复查结果及术后生存率。结果：两组手术相关指标、术后近期并发症、术后1年和3年生存率差异均无统计学意义（均 P ＞0．05）。远期并发症中，B －II ＋Braun 组烧心／返流、倾倒综合征的发生率（分别为20．83％、16．67％）显著高于 Roux －en －Y 组（均为4．17％），差异有统计学意义（P ＜0．05）。术后1年以上内镜检查结果显示 Roux －en －Y 组反流性胃炎、胆汁反流及反流性食管炎发生率（分别为31．25％、18．75％、9．38％）显著低于 B －II ＋Braun 组（分别为72．22％、61．11％、36．11％），差异有统计学意义（P ＜0．05）；食物潴留方面，两组差异无统计学意义（P ＞0．05）。结论：胃癌远端胃大部切除术后行Roux －en －Y 重建术后抗返流效果显著优于 B －II ＋Braun，且在手术安全性及术后生存率方面无明显劣势。前者可替代后者，值得在临床推广应用。