三种胃肠道重建术式在胃癌根治术中的应用效果及安全性研究  

Application effect and safety of three gastrointestinal reconstruction methods in radical gastrectomy for gastric cancer

作　　者：吴培华 忽维维 童永康 WU Pei-hua;HU Wei-wei;TONG Yong-kang(Department of General Surgery,Baoji High-tech Hospital,Baoji 721000,Shaanxi,CHINA)

机构地区：[1]宝鸡高新医院普通外科,陕西宝鸡721000

出　　处：《海南医学》2023年第17期2489-2493,共5页Hainan Medical Journal

基　　金：陕西省重点研发计划项目(编号:2018SF-054)。

摘　　要：目的研究三种胃肠道重建术式在胃癌根治术中的应用效果及安全性。方法回顾性分析2019年10月至2022年10月期间宝鸡高新医院普通外科收治的80例行胃癌根治术患者的临床资料。根据不同的胃肠道重建术方式将其分为Y组25例、Braun+Ⅱ组28例、Ⅰ组27例,Y组实施Uncut Roux-en-Y吻合术,Braun+Ⅱ组实施Braun吻合术+Billroth-Ⅱ式,Ⅰ组实施Billroth-Ⅰ式改良三角吻合术,比较三组患者的手术时间、术中出血量、首次排气时间、首次排便时间,术前及术后5 d内毒素(ETX)、二胺氧化酶(DAO)、D-乳酸水平、白细胞介素-6(IL-6)、白细胞介素-10(IL-10)水平及术后并发症发生情况。结果Ⅰ组患者的手术时间及术中出血量分别为(124.85±11.34)min、(55.62±10.54)mL,明显短于或少于Y组的(144.35±14.56)min、(71.54±12.68)mL和Braun+Ⅱ组的(130.56±12.62)min、(63.46±9.57)mL,且Y组明显短于或少于Braun+Ⅱ组,差异均有统计学意义(P<0.05);Ⅰ组患者的首次排气时间、排便时间分别为(30.28±4.58)h、(33.59±9.46)h,明显短于Y组的(34.48±6.85)h、(39.56±8.06)h与Braun+Ⅱ组的(33.84±5.76)h、(38.86±10.12)h,差异均有统计学意义(P<0.05),但Braun+Ⅱ组与Y组比较差异无统计学意义(P>0.05);术前,三组患者的ETX、DAO、D-乳酸水平比较差异均无统计学意义(P>0.05),术后5 d,三组患者的ETX、DAO、D-乳酸水平较术前均升高,且Ⅰ组患者的ETX、DAO、D-乳酸水平明显低于Y组和Braun+Ⅱ组,差异均有统计学意义(P>0.05);术前,三组患者的IL-6、IL-10水平比较差异无统计学意义(P>0.05),术后5 d,三组患者的IL-6、IL-10水平较术前明显升高,且Ⅰ组患者的IL-6、IL-10水明显高于Y组和Braun+Ⅱ组,差异均有统计学意义(P>0.05);三组患者的术后并发症总发生率比较差异无统计学意义(P>0.05)。结论Billroth-Ⅰ式改良三角吻合术具有出血少、术后恢复快、安全性高等优点,且对患者胃肠道的影响较小,但Uncut RouObjective To study the application effect and safety of three types of gastrointestinal reconstruction techniques in radical gastrectomy for gastric cancer.Methods A retrospective study was conducted on 80 patients who underwent radical gastrectomy for gastric cancer in Department of General Surgery,Baoji High-tech Hospital from October 2019 to October 2022.According to different methods of gastrointestinal reconstruction,they were divided into Y group with 25 cases,Braun+Ⅱ group with 28 cases,and Ⅰ group with 27 cases.Y group underwent Uncut Roux-en-Y anastomosis,Braun+Ⅱ group underwent Braun anastomosis+Billroth-Ⅱ procedure,and Ⅰ group underwent Billroth-Ⅰ modified triangular anastomosis.The surgical time,intraoperative bleeding volume,first exhaust time,first defecation time,and endotoxin(ETX),diamine oxidase(DAO),D-lactate levels,interleukin-6(IL-6),interleukin-10(IL-10)levels before surgery and 5 d after surgery,as well as postoperative complications were compared among the three groups of patients.Results The surgical time and intraoperative bleeding volume in Ⅰ group were(124.85±11.34)min and(55.62±10.54)mL,which were significantly shorter or less than(144.35±14.56)min and(71.54±12.68)mL in Y group and(130.5±12.62)min and(63.46±9.57)mL in Braun+Ⅱ group;the two indexes in Y group were significantly shorter or less than those in Braun+Ⅱ group;the differences were statistically significant(P<0.05).The first exhaust time and defecation time of Ⅰ group were(30.28±4.58)h and(33.59±9.46)h,which were significantly shorter than(34.48±6.85)h and(39.56±8.06)h of Y group and(33.84±5.76)h and(38.86±10.12)h of Braun+Ⅱ group,with statistically significant differences(P<0.05).Before surgery,there was no statistically significant difference in ETX,DAO,and D-lactate levels among the three groups of patients(P>0.05);on the 5th day after surgery,the levels of ETX,DAO,and D-lactate in the three groups increased significantly compared to those before surgery,and the levels in Ⅰ group were sig

关 键 词：胃癌 胃肠道重建术 Uncut Roux-en-Y吻合术 Braun吻合术 Billroth-Ⅰ式改良三角吻合术 胃功能 

分 类 号：R735.2[医药卫生—肿瘤]