胃癌根治术后3种胃肠道重建术式的治疗效果及并发症的比较  

Comparison of treatment effects and complications of three kinds of gastrointestinal reconstruction procedures after radical gastrectomy

作　　者：陈徽[1] 朱晓明[1] 罗振凌[1] 沈佳慧 顾群浩[1] 周嘉[2] CHEN Hui;ZHU Xiaoming;LUO Zhenling;SHEN Jiahui;GU Qunhao;ZHOU Jia(Department of Gastrointestinal Surgery,Yueyang Integrated Traditional Chinese and Western Medicine Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 200437,China;Department of Cardiothoracic Surgery,Yueyang Integrated Traditional Chinese and Western Medicine Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 200437,China)

机构地区：[1]上海中医药大学附属岳阳中西医结合医院胃肠外科,200437 [2]上海中医药大学附属岳阳中西医结合医心胸外科,200437

出　　处：《天津医药》2022年第10期1066-1071,共6页Tianjin Medical Journal

基　　金：上海市卫生和计划生育委员会科研项目(201840011)。

摘　　要：目的比较胃癌根治术后3种重建术式的治疗效果及并发症情况。方法选择194例胃癌根治术患者,根据胃肠道重建方式分为U-RY组(Uncut Roux-en-Y吻合)69例、BⅠ组(Billroth-Ⅰ式改良三角吻合)65例、BⅡ+Braun组(Billroth-Ⅱ式+Braun吻合)60例,采用倾向性评分匹配对3组基本资料进行匹配,比较3组手术和术后恢复情况、肠道屏障功能[二胺氧化酶(DAO)、D-乳酸、内毒素(ETX)]、炎症应激[白细胞介素-6(IL-6)、IL-10、8-异-前列腺素F2α(8-iso-PGF2α)、血红素加氧酶-1(HO-1)]及并发症情况。结果倾向性评分匹配前,3组患者性别、年龄分布不均衡(P<0.05),匹配后,194例患者中配对成功147例,每组49例,3组患者一般资料比较差异无统计学意义(P>0.05);BⅠ组、BⅡ+Braun组及U-RY组手术时间依次增加(P<0.05);BⅠ组术中出血量和术后肠鸣音恢复时间、首次排气、拔管、进食、首次排便、住院时间短于BⅡ+Braun组和U-RY组(P<0.05),BⅡ+Braun组和U-RY组上述指标比较差异无统计学意义(P>0.05)。术后3 d,相较于U-RY组和BⅡ+Braun组,BⅠ组DAO、D-乳酸、ETX水平更低,IL-6、IL-10、8-iso-PGF2α、HO-1水平更高(P<0.05),U-RY组和BⅡ+Braun组上述指标比较差异无统计学意义(P>0.05);3组并发症发生率比较差异无统计学意义(P>0.05)。结论BillrothⅠ式改良三角吻合较Billroth-Ⅱ式+Braun吻合、Uncut Roux-en-Y吻合有术程短、出血少、恢复快、对肠道屏障影响小的优势,但后两者适应证更广、炎症刺激轻,且Uncut Roux-en-Y吻合可有效减少术后反流。Objective To compare the treatment effects and complications of three reconstruction procedures in patients after radical gastrectomy.Methods A total of 194 patients with radical gastrectomy were selected and divided into the U-RY group(Uncut Roux-en-Y anastomosis,69 cases),the BⅠgroup(Billroth-Ⅰmodified delta-shaped anastomosis,65 cases)and the BⅡ+Braun group(BillrothⅡ+Braun anastomosis,60 cases)according to the gastrointestinal reconstruction methods.The basic data of the three groups were matched by propensity score matching.The surgical status,postoperative recovery status,intestinal barrier function[diamine oxidase(DAO),D-lactic acid,endotoxin(ETX)],inflammatory stress indicators[interleukin-6(IL-6),interleukin-10(IL-10),8-iso-prostaglandin F2α(8-iso-PGF2α),heme oxygenase-1(HO-1)]and complications were compared between the three groups.Results Before propensity score matching,gender and age were not evenly distributed in the three groups(P<0.05).After matching,147 cases of 194 patients were successfully matched,with 49 cases in each group.There were no significant differences in general data between the three groups(P>0.05).The surgical time increased successively in the BⅠgroup,the BⅡ+Braun group and the U-RY group(P<0.05).The intraoperative blood loss,postoperative bowel sound recovery time,first exhaust time,extubation time,eating time,first defecation time and hospital stay were less or shorter in the BⅠgroup than those in the B Ⅱ+Braun group and the U-RY group (P<0.05), but there were no significant differences in the above indicators between the B Ⅱ+Braun group and the U-RY group (P>0.05). At 3 d after surgery, the levels of DAO, D-lactic acid and ETX were significantly lower in the B Ⅰ group than those of the U-RY group and the B Ⅱ+Braun group, while the levels of IL-6, IL 10, 8-iso-PGF2α and HO-1 were higher compared with those in the U-RY group and the B Ⅱ+Braun group (P<0.05). There were no significant differences in the above indicators between the U-RY group and the B �

关 键 词：胃肿瘤 胃癌根治术 BillrothⅠ式改良三角吻合 Billroth-Ⅱ式+Braun吻合 Uncut Roux-en-Y吻合 肠道屏障功能 

分 类 号：R735.2[医药卫生—肿瘤]