腹腔镜下非离断式Roux-en-Y与BillrothⅡ- Braun消化道重建的安全性及卫生经济学比较——单中心前瞻性队列研究  

Comparison of the safety and the costs between laparoscopic assisted or totally laparoscopic uncut Roux-en-Y and BillrothⅡ＋Braun reconstruction-a single center prospective cohort study

作　　者：王胤奎[1] 李子禹[1] 陕飞[1] 张连海[1] 李双喜[1] 贾永宁[1] 陈宇帆 薛侃[1] 苗儒林[1] 李浙民 高翔宇[1] 闫超[1] 李沈[1] 吴舟桥[1] 季加孚[1] Wang Yinkui;Li Ziyu;Shan Fei;Zhang Lianhai;Li Shuangxi;Jia Yongning;Chen Yufan;Xue Kan;Miao Rulin;Li Zhemin;Gao Xiangyu;Yan Chao;Li Shen;Wu Zhouqiao;Ji Jiafu(Department of Gastrointestinal Surgery, Key Laboratory of Carcinogenesis and Translational Research （Ministry of Education） , Peking University Cancer Hospital ＆ Institute, Beijing 100142, China)

机构地区：[1]北京大学肿瘤医院暨北京市肿瘤防治研究所胃肠肿瘤中心 恶性肿瘤发病机制及转化研究教育部重点文验室,100142

出　　处：《中华胃肠外科杂志》2018年第3期312-317,共6页Chinese Journal of Gastrointestinal Surgery

基　　金：北京市科学技术委员会首都临床特色应用发展项目（z151100004015070）;科技部支撑计划（2014BAI09B02）;北京市医院管理局重点医学专业发展计划胃癌专业（ZYLX201701）

摘　　要：目的比较腹腔镜辅助或全腹腔镜下远端胃癌根治术后非离断式Roux-en-Y与BillrothⅡ（BⅡ）- Braun两种消化道重建方式的短期安全性及卫生经济学结果。方法系统分析北京大学肿瘤医院暨北京市肿瘤防治研究所胃肠肿瘤中心胃癌根治手术前瞻性研究队列中收录的自2015年3月1日至2017年6月30日期间行腹腔镜远端胃癌根治术、采用非离断式Roux-en-Y吻合（非离断式Roux-en-Y组）或BⅡ-Braun吻合（BⅡ-Braun组）进行消化道重建患者的临床资料。两种消化道重建方式均采用直线切割闭合器完成，其中，非离断Roux-en-Y组输入袢近端肠管只闭合不离断，采用45 mm无刀腔镜下切割闭合器（ATS45NK）完成。组间计量资料采用独立样本t检验或相应的非参数检验，组间计数资料采用χ^2检验或Fisher精确概率法。结果非离断式Roux-en-Y组81例，BⅡ-Braun组58例；两组患者的中位年龄（56.0岁比56.5岁，P = 0.757）、性别比例[例（男/女）：52/29比46/12，P = 0.054]、腹部手术病史[例（有/无），10/71比4/54，P = 0.293]、术前新辅助化疗[例（有/无），21/60比11/47，P = 0.336]、体质指数[例（消瘦/正常/超重/肥胖）：3/49/26/3比3/39/14/2，P = 0.591]、NRS 2002营养评分[例（1/2/3/4）：58/15/5/3比47/5/3/3，P = 0.403]、肿瘤TNM分期[例（0/Ⅰ/Ⅱ/Ⅲ）：3/41/20/17比1/28/13/16，P = 0.755]、肿瘤中位长径（2.5 cm比3.0 cm，P = 0.278）、肿瘤中位短径（2.0 cm比2.0 cm，P = 0.126）等临床病理因素比较，差异无统计学意义。术后非离断式Roux-en-Y组与BⅡ-Braun组Ⅱ度及以上并发症发生率[12.3%（10/81）比17.2%（10/58），P = 0.417]、吻合口并发症发生率[1.2%（1/81）比0，P = 1.000]以及住院费用[（9.4±1.4）万元比（9.5±1.6）万元，P = 0.895]比较，差异均无统计学意义；但非离断式Roux-en-Y组患者的术后首次全流食中位时间（57.1 h比70.8 h，P = 0.017）及中位术后�ObjectiveTo compare the short-term safety and costs between laparoscopic assisted or totally laparoscopic uncut Roux-en-Y and Billroth Ⅱ （B Ⅱ） ＋ Braun reconstruction after radical gastrectomy of distal gastric cancer.MethodsClinical data from our prospective database of radical gastrectomy were systematically analyzed. The patients who underwent laparoscopic gastrectomy with uncut Roux-en-Y or BⅡ＋ Braun reconstruction between March 1st, 2015 and June 30th, 2017 were screened out for further analysis. Both the reconstructions were completed by linear staplers. Uncut Roux-en-Y reconstruction was performed with a 45 mm no-knife linear stapler （ATS45NK） on the afferent loop below the gastrojejunostomy. Continuous variables were compared using independent samples t test or Mann-Whitney U. The frequencies of categorical variables were compared using Chi-squared or Fisher exact test.ResultsEighty-one patients were in uncut Roux-en-Y group and 58 patients were in BⅡ＋Braun group. There were no significant differences between uncut Roux-en-Y group and BⅡ＋Braun group in median age （56.0 years vs. 56.5 years, P = 0.757） , gender （male/female, 52/29 vs. 46/12, P = 0.054） , history of abdominal surgery （yes/no, 10/71 vs. 4/54, P = 0.293） , neoadjuvant chemotherapy （yes/no, 21/60 vs. 11/47, P = 0.336） , BMI （thin/normal/overweight/obesity, 2/49/26/3 vs. 3/39/14/2, P = 0.591） , NRS 2002 score （1/2/3/4, 58/15/5/3 vs. 47/5/3/3, P = 0.403） , pathological stage （0/Ⅰ/Ⅱ/Ⅲ, 3/41/20/17 vs. 1/28/13/16, P = 0.755） , median tumor diameter in long axis （2.5 cm vs. 3.0 cm, P = 0.278） , median tumor diameter in short axis （2.0 cm vs. 2.0 cm, P = 0.126） and some other clinical and pathological characteristics. There were no significant differences between uncut Roux-en-Y group and BⅡ＋Braun group in morbidity of postoperative complication more severe than grade I [12.3% （10/81） vs. 17.2% （10/58） , P= 0.417], morbidity of anastomotic complication [1.2% （1/81） vs.

关 键 词：胃肿瘤 消化道重建 非离断式Roux—en—Y BILLROTH Ⅱ+Braun 全腹腔镜 安全性 卫生经济学 

分 类 号：R735.2[医药卫生—肿瘤]