根治性远端胃切除后3种消化道重建方式的疗效比较  

Comparison of Outcomes of Three Reconstruction Methods for Radical Distal Gastrectomy:A Matched Study

作　　者：柳金强 张瑞[1] 周威[1] 张磊[1] 马娇娇[1] 杨学文[1] 肖书傲 连肖[1] 郭曼[1] 张洪伟[1] 洪流[1] 

机构地区：[1]第四军医大学附属西京消化病医院消化外科,陕西西安710032 [2]武汉联勤保障基地信阳干休所,河南信阳464000

出　　处：《中国普外基础与临床杂志》2016年第12期1477-1482,共6页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的探讨根治性远端胃切除术后理想的消化道重建方式。方法回顾性分析2010年1月至2013年1月期间于第四军医大学附属西京消化病医院接受根治性远端胃切除术的862例患者的临床及随访资料,根据消化道重建方式分为Roux-en-Y组、BillrothⅡ式吻合+Braun组(B-Ⅱ+Braun组)及BillrothⅠ式吻合组(B-Ⅰ组),再按性别、年龄(差异<5岁)、肿瘤直径(差异<1 cm)、肿瘤p T分期及肿瘤p N分期为匹配变量,行Gmatch配比以减少组间患者临床病理学特征的差异后,比较3组的围手术期相关指标、术后近期(30 d内)并发症、术后1年以上胃镜复查结果及术后生存情况。结果 1围手术期相关指标。3组患者的手术时间、术后首次进半流食的时间及术后住院时间均不同(P<0.050):B-Ⅰ组的手术时间短于Roux-en-Y组和B-Ⅱ+Braun组(P<0.012 5),但Roux-en-Y组和B-Ⅱ+Braun组比较差异无统计学意义(P>0.012 5);B-Ⅰ组术后首次进半流食的时间较B-Ⅱ+Braun组早(P<0.012 5),但Roux-en-Y组和B-Ⅱ+Braun组比较、Roux-en-Y组和B-Ⅰ组比较差异均无统计学意义(P>0.0125);B-Ⅱ+Braun组和B-Ⅰ组的术后住院时间均短于Roux-en-Y组(P<0.012 5),但B-Ⅱ+Braun组和B-Ⅰ组比较差异无统计学意义(P>0.012 5)。2术后近期并发症。Roux-en-Y组、B-Ⅱ+Braun组及B-Ⅰ组分别发生并发症4例(12.5%,4/32)、2例(6.2%,2/32)及1例(3.1%,1/32),但3组患者的并发症发生率比较差异无统计学意义(P=0.495)。3术后1年以上胃镜复查结果。3组患者的反流性胃炎、胆汁反流及反流性食管炎的发生率均不同(P<0.050):Roux-en-Y组的反流性胃炎、胆汁反流及反流性食管炎发生率均低于B-Ⅱ+Braun组和B-Ⅰ组(P<0.012 5),但B-Ⅱ+Braun组和B-Ⅰ组的反流性胃炎、胆汁反流及反流性食管炎发生率比较差异均无统计学意义(P>0.012 5)。4生存情况。Roux-en-Y组、B-Ⅱ+Braun组及B-Ⅰ组的3年生存率分别为70.0%(21/30)、73.3%(22/30)及75.0%(24/32),且3组患�Objective To investigate the ideal digestive tract reconstruction method for radical distal gastrectomy （DG）. Methods Clinical and follow-up data of 862 patients with gastric cancer who underwent DG in Xi）ing Hospital of Digestive Diseases of The Fourth Military Medical University from January 2010 to January 2013 were analyzed retrospectively. According to reconstruction methods, patients were divided into three groups： Billroth I group （B- I group）, Billroth Ⅱ （B-Ⅱ）＋Braun group （B-Ⅱ＋Braun group）, and Roux-en-Y group. In order to reduce the difference of clinicopathological characteristics, Gmatch method was used to select patients basing on gender, age （±5 years）, tumor size （±1 cm）, pT staging, and pN staging. The perioperative data, recent （30 days after surgery） complications, gastroscopic results over one year, and postoperative survival rate were compared respectively among the 3 groups. Results （1） Perioperative indexes. The operative time, postoperative hospitalization, and semi liquid diet time were significantly different among 3 groups （P〈0.050）. As compared with B-Ⅱ ＋Braun group and Roux-en-Y group, B-I group had a significantly shorter operative time （P〈0.012 5）, and there was no significant difference between B-Ⅱ＋Braun group and Roux-en-Y group （P〉 0.012 5）. As compared with B-Ⅱ＋Braun group, B-I group had a significantly shorter semi liquid diet time （P〈0.012 5）, but there was no significant difference between B- Ⅱ ＋Braun group and Roux-en-Y group, as well as Roux-en-Y group and B-I group （P〉0.012 5）. As compared with B-I group and B-Ⅱ＋Braun group, Roux-en-Y group had a significantly longer postoperative hospitalization （P〈0.012 5）, and there was no significant difference between B-I group and B-Ⅱ ＋ Braun group （P〉0.012 5）. （2） There was no significant difference in recent complications between Roux-en-Y group （12.5%, 4/32）, B-Ⅱ＋Braun（6.2%, 2/32）, and B-I group （3.1%,

关 键 词：胃癌 消化道重建 远端胃切除 并发症 预后 

分 类 号：R735.2[医药卫生—肿瘤]