远端胃癌患者毕Ⅰ式与毕Ⅱ式吻合术后并发症及远期生存比较  

Comparison of long-term survival and postoperative complications between Billroth Ⅰ and Ⅱ reconstruction in patients with distal gastric cancer

作　　者：刘震[1] 刘书尚 徐光辉[1] 丰帆[1] 郭曼[1] 连肖[1] 柰超[1] 杨学文[1] 柳金强 郑高赞 张洪伟[1] 

机构地区：[1]第四军医大学附属西京医院消化一科,西安710032

出　　处：《中华胃肠外科杂志》2016年第7期785-788,共4页Chinese Journal of Gastrointestinal Surgery

基　　金：国家自然科学基金（31100643,31570907,81572306,81502403,81300301）,陕西省社会发展攻关计划项目（2014SF2-14）,第四军医大学西京医院助推计划项目（XJZT12203）

摘　　要：目的比较远端胃癌根治性切除毕Ⅰ式与毕Ⅱ式吻合术后并发症及远期生存情况。方法回顾性分析2008年5月至2015年4月期间第四军医大学西京医院消化外科收治的992例行D2根治性远端胃切除术患者的临床资料，其中毕Ⅰ式吻合207例（毕Ⅰ组），毕Ⅱ式吻合785例（毕Ⅱ组）。采用SAS9.3软件，以年龄（±10岁）、性别、肿瘤大小（±1cm）、病理类型、浸润深度为匹配变量，对毕Ⅰ组和毕Ⅱ组病例行gmateh配对，减少组间病理特征差异，成功匹配191对患者。比较两组患者术后并发症发生率和3年总体生存率。结果两组患者年龄、性别、肿瘤大小、病理类型、浸润深度、淋巴结转移及TNM分期等基线资料的差异均无统计学意义（P〉0．05）。毕Ⅰ组较毕Ⅱ组，手术时间缩短[（181．7±57．0）min比（220．7±68．8）min，t=-6．038，P=0．000]，住院时间也较短[（7．6±2．7）d比（8．1±2．8）d，t=-1．920，P=0．046]。两组患者间术后并发症包括吻合口瘘、切口裂开、切口感染、腹腔出血、肠梗阻、十二指肠残端瘘、呼吸道感染和发热等发生率的差异无统计学差异（均P〉0．05）。毕Ⅰ组与毕Ⅱ组患者的3年生存率分别为82．9％和78．7％，差异无统计学意义（P=0．379）。结论与毕Ⅱ式相比，毕Ⅰ式吻合作为根治性远端胃切除术的吻合方式更为适宜。Objective To compare the long-term survival and postoperative complications of distal gastric cancer patients between Billroth Ⅰ （B Ⅰ ） and Billroth Ⅱ （B Ⅱ ） reconstruction. Methods Clinicopathological data of 992 patients with distal gastric cancer who underwent D2 curative gastrectomy in our department from May 2008 to April 2015 were recorded, including 207 patients of B Ⅰ reconstruction and 785 of B Ⅱ reconstruction, were retrospectively analyzed. Patients presenting a previous history of cancer, gastric resection or cytotoxic chemotherapy, and those presenting liver or intraperitoneal tumor dissemination or unresectable infiltration into contiguous organs were excluded. Patients in B Ⅰ and B Ⅱ group were selected using gmateh methods based on age （±10 years）, gender, tumor size （±1 cm）, differentiated degree and depth of invasion in order to reduce the selection bias of elinicopathological characteristics. The final number of patients matched was 191 respectively. Results Compared with B Ⅱ group, the B Ⅰ group had a significantly shorter operation time （181.7 min vs. 220.7 min, P = 0.000） and a shorter postoperative hospitalization stay （7.6 days vs. 8.1 days, P = 0.046）. The postoperative complications including anastomotic leakage, wound dehiscence, wound infection, intraperitoneal hemorrhage, intestinal obstruction, duodenal stump fistula, pulmonary infection and fever had no significant difference （P 〉 0.05）. Three-year survival between two groups was comparable （82.9% vs. 78.7%, P = 0.379）. Conclusions Compared with B Ⅱ, 13 Ⅰ reconstruction is more suitable for patients with distal gastric cancer.

关 键 词：胃肿瘤 远端 根治性远端胃切除术 吻合方式 毕Ⅰ式 毕Ⅱ式 并发症 生存 

分 类 号：R735.2[医药卫生—肿瘤]