胃十二指肠吻合术、胃空肠吻合术、胃空肠 Roux-en-Y式吻合术治疗胃癌疗效及安全性分析  

Efficacy and safety of BillrothⅠ,BillrothⅡand Roux-en-Y anastomosis in treatment of gastric cancer

作　　者：马福军 钱征 MA Fujun;QIAN Zheng(Department of Digestive Surgery,Xi'an International Medical Center Hospital,Xi'an 710100,China)

机构地区：[1]西安国际医学中心医院消化外科,陕西西安710100

出　　处：《陕西医学杂志》2022年第6期729-732,748,共5页Shaanxi Medical Journal

基　　金：陕西省重点研发计划项目(2019SF-046)。

摘　　要：目的:探讨胃十二指肠吻合术(BillrothⅠ)、胃空肠吻合术(BillrothⅡ)、胃空肠Roux-en-Y式吻合术(Roux-en-Y)治疗胃癌的疗效及安全性。方法:回顾性分析行胃癌根治术后消化道重建的80例患者的临床资料,以术后重建方式不同分为B-Ⅰ组(21例)、B-Ⅱ组(29例)及R-Y组(30例)。比较三组围手术期指标(手术时间、术中出血量和住院时间)、术后恢复指标[术后排气时间、术后进食时间和预后营养指数(PNI)]、胃功能指标(胃管拔除时间、胃排空时间和血浆胃动素水平)以及并发症发生情况。结果:B-Ⅰ组手术时间及术中出血量显著少于B-Ⅱ组和R-Y组,而B-Ⅱ组手术时间及术中出血量显著少于R-Y组(均P<0.05)。B-Ⅱ组术后排气时间、术后进食时间及PNI显著大于B-Ⅰ组和R-Y组(均P<0.05),但B-Ⅰ组与R-Y组术后排气时间、术后进食时间及PNI比较差异无统计学意义(均P>0.05)。B-Ⅱ组胃排空时间显著多于B-Ⅰ组和R-Y组,血浆胃动素水平显著低于B-Ⅰ组和R-Y组(均P<0.05),但B-Ⅰ组与R-Y组胃排空时间及血浆胃动素水平比较差异无统计学意义(均P>0.05)。R-Y组反流性食管炎、胆汁反流、残胃炎发生率显著低于B-Ⅰ组与B-Ⅱ组(均P<0.05),但B-Ⅰ组与B-Ⅱ组反流性食管炎、胆汁反流、残胃炎发生率比较差异无统计学意义(均P>0.05)。B-Ⅰ组吻合口瘘发生率显著高于B-Ⅱ组与R-Y组(均P<0.05),但B-Ⅱ组与R-Y组吻合口瘘发生率比较差异无统计学意义(P>0.05)。结论:BillrothⅠ术式操作简单,手术时间短;BillrothⅡ术式无明显优势,临床运用较少;Roux-en-Y术式则是较为理想的重建方式,能有效避免术后胃肠道功能性并发症。Objective:To explore the efficacy and safety of gastroduodenostomy(BillrothⅠ),gastrojejunostomy(BillrothⅡ)and gastrojejunostomy Roux-en-Y anastomosis(Roux-en-Y)in the treatment of gastric cancer.Methods:The clinical data of 80 patients with digestive tract reconstruction after radical gastrectomy were retrospectively analyzed.The patients were divided into B-Ⅰgroup(21 cases)and B-Ⅱgroup(29 cases)and R-Y group(30 cases)according to the different postoperative reconstruction methods.Perioperative indexes(operative time,intraoperative blood loss and hospital stay),postoperative recovery indexes(postoperative exhaust time,postoperative feeding time and PNI),gastric function indexes(gastric tube removal time,gastric emptying time and plasma motilin level)and complications were compared among the three groups.Results:The operation time and intraoperative blood loss in B-Ⅰgroup were significantly less than those in B-Ⅱand R-Y group,while the operation time and intraoperative blood loss in B-Ⅱgroup were significantly less than those in R-Y group(all P<0.05).The postoperative exhaust time,postoperative feeding time and PNI in B-Ⅱgroup were significantly higher than those in B-Ⅰgroup and R-Y group(all P<0.05),but there was no significant difference in postoperative exhaust time,postoperative feeding time and PNI between B-Ⅰgroup and R-Y group(all P>0.05).The gastric emptying time of B-Ⅱgroup was significantly higher than that of B-Ⅰgroup and R-Y group,and the plasma motilin level was significantly lower than that of B-Ⅰgroup and R-Y group(all P<0.05),but there was no significant difference in gastric emptying time and plasma motilin level between B-Ⅰgroup and R-Y group(all P>0.05).The incidence of reflux esophagitis,bile reflux and residual gastritis in R-Y group was significantly lower than that in B-Ⅰgroup and B-Ⅱgroup(all P<0.05),but there was no significant difference in the incidence of reflux esophagitis,bile reflux and residual gastritis between B-Ⅰgroup and B-Ⅱgroup(all P>0.05).T

关 键 词：胃癌 胃十二指肠吻合术 胃空肠吻合术 胃空肠Roux-en-Y式吻合术 疗效 安全性 

分 类 号：R735.2[医药卫生—肿瘤]