空肠侧侧吻合术在胃癌手术应用的远期疗效研究  

LONG-TERM EFFECT OF JEJUNAL ANASTOMOSIS IN GASTRIC CANCER

作　　者：贾世峰 朱建权 郑彬 闫丰 JIA Shifeng;ZHU Jianquan;ZHENG Bin;YAN Feng(Department of Surgical Oncology,Affiliated Hospital of North China University of Science and Technology,Tangshan 063100,China)

机构地区：[1]华北理工大学附属医院肿瘤外科,河北省唐山市063000 [2]天津医科大学肿瘤医院肿瘤外科 [3]开滦总医院

出　　处：《中国煤炭工业医学杂志》2022年第3期294-298,共5页Chinese Journal of Coal Industry Medicine

基　　金：2021年河北省医学科学研究课题计划(编号:20211213)。

摘　　要：目的 探讨术中应用直线切割闭合器行空肠侧侧吻合术(JSA)对胃癌根治术Bill-rothⅡ胃肠吻合术后远期疗效的影响。方法 回顾性病例对照研究华北理工大学附属医院2014年5月—2019年4月行胃癌BⅡ式的手术患者89例,按是否加做直线切割闭合器行空肠侧侧吻合术分为改良组(46例)和对照组(43例)。比较二组患者吻合口溃疡(AU),术后吻合口复发(PAR),胆汁返流性胃炎(BRG)、上腹部疼痛、食欲不振等远期并发症发生情况,比较二组患者术后HGB、RBC、Ca^(2+)反应营养吸收状况指标。结果 二组患者性别(P=0.593)、年龄(P=0.723)、术前RBC(P=0.720)、HGB(P=0.946)、血Ca^(2+)(P=0.367)、病变部位(P=0.858)、病理类型(P=0.946)、病理分期(P=0.991)基线资料的差异均无统计学意义(P>0.05)。二组患者比较吻合口溃疡(AU)(P=0.041),胆汁返流性胃炎(BRG)(P=0.000),上腹部疼痛(P=0.037),食欲不振(P=0.002)差异有统计学意义(P<0.05),吻合口复发(PAR)(P=0.953),差异无统计学意义(P>0.05),二组患者术后比较HGB分别为(116.94±12.33)g/L与(110.94±11.98)g/L(t=2.326,P=0.022),RBC分别为(4.54±0.65)10^(12)/L与(4.25±0.45)10^(12)/L(t=2.439,P=0.017),Ca^(2+)分别为(2.39±0.17)mmol/L与(2.18±0.22)mmol/L(t=5.073,P=0.000),指标差异有统计学意义(P<0.05)。结论 胃癌Bill-rothⅡ胃肠吻合手术应用空肠侧侧吻合术(JSA),能减少患者术后吻合口溃疡(AU),胆汁返流性胃炎(BRG),上腹部疼痛、食欲不振等远期并发症,改善患者术后远期营养吸收水平。Objective To investigate the effect of intraoperative linear cutting and closure device for jejunal side to side anastomosis(JSA) on the long-term efficacy of Bill-roth Ⅱ gastrointestinal anastomosis after radical gastrectomy for gastric cancer.Methods A retrospective case-control study of eighty-nine patients who underwent BⅡ surgery for gastric cancer from May 2014 to April 2019 in Affiliated Hospital of North China University of Science and Technology.Improved group(forty-six Cases) and control group(forty-three cases).The two groups were compared in terms of anastomotic ulcer(AU),postoperative anastomotic recurrence(PAR),bile reflux gastritis(BRG),and upper abdominal pain.The occurrence of long-term complications such as loss of appetite, and postoperative HGB,RBC,and Caresponse indicators of nutrient absorption were compared between the two groups.Results Gender(P=0.593),age(P=0.723),preoperative RBC(P=0.720),HGB(P=0.946),blood Ca(P=0.367),lesion location(P=0.858),pathological There was no significant difference in baseline data of type(P=0.946) and pathological stage(P=0.991)(P>0.05).There were statistically significant differences in anastomotic ulcer(AU)(P=0.041),bile reflux gastritis(BRG)(P=0.000),epigastric pain(P=0.037) and loss of appetite(P=0.002) between the two groups of patients(P<0.05),anastomotic recurrence(PAR)(P=0.953),no statistical significance(P>0.05),postoperative HGB of the two groups were(116.94±12.33) g/L and(110.94±11.98) g/L(t=2.326,P=0.022),RBC were(4.54±0.65) 10/L and(4.25±0.45) 10/L(t=2.439,P=0.017),and Cawere(2.39±0.17) mmol/L and(2.18±0.22) mmol/L(t=5.073,P=0.000) indicators were statistically significant(P<0.05).Conclusion Side-to-side jejunostomy(JSA) in Bill-roth Ⅱ gastrointestinal anastomosis for gastric cancer can reduce postoperative anastomotic ulcer(AU),bile reflux gastritis(BRG),epigastric pain, loss of appetite and other long-term complications.It can improve the long-term nutritional absorption level of patients after operation.

关 键 词：Bill-rothⅡ胃肠吻合 空肠侧侧吻合术 远期疗效 

分 类 号：R615[医药卫生—外科学]