BillrothⅡ式与Roux-en-Y吻合在腹腔镜下远端胃癌根治术中的疗效比较  

Efficacy of Billroth II anastomosis versus Roux-en-Y anastomosis in laparoscopic distal gastrectomy for gastric cancer

作　　者：曹辉[1] 江永强[1] 刘罗海 郑涛[1] 姜宝 Cao Hui;Jiang Yongqiang;Liu Luohai;Zheng Tao;Jiang Bao(Department of General Surgery,General Hospital of Huainan Oriental Hospital Group,Huainan 232001,Anhui Province,China)

机构地区：[1]淮南东方医院集团总医院普外科,淮南232001

出　　处：《中国基层医药》2024年第9期1363-1367,共5页Chinese Journal of Primary Medicine and Pharmacy

基　　金：安徽省淮南市科技计划(2021A251)。

摘　　要：目的比较BillrothⅡ式与Roux-en-Y吻合两种不同吻合方式在腹腔镜辅助远端胃癌根治术中的疗效。方法采用病例对照研究,回顾性分析淮南东方医院集团2021年1月至2022年12月因胃癌接受腹腔镜辅助远端胃癌根治手术患者110例的临床资料,根据远端胃大部切除术后消化道重建方式不同分为观察组61例、对照组49例。观察组采用Roux-en-Y吻合,对照组采用BillrothⅡ式吻合。比较两组术中出血量、手术时间、术后恢复情况、术后下床活动时间、肛门排气时间、进食情况、住院时间及并发症发生情况。结果对照组手术时间为(140.0±31.5)min,明显短于观察组的(180.0±30.5)min,差异有统计学意义(t=6.37,P<0.05);两组术中出血量、术后早期下床活动时间差异均无统计学意义(均P>0.05)。对照组并发碱性反流性胃炎8例(16.3%)、输入袢梗阻3例(6.1%)、倾倒综合征3例(6.1%),均显著高于观察组的2例(3.3%)、1例(1.6%)、1例(1.6%),差异均有统计学意义(χ ^(2)=6.15、4.54、4.54,均P<0.05)。结论使用Roux-en-Y吻合对腹腔镜远端胃癌根治术的患者进行消化道重建能够预防碱性反流性胃炎、输入袢梗阻以及倾倒综合征的出现,但手术时间较长。Objective To investigate the efficacy of Billroth Ⅱ anastomosis versus Roux-en-Y anastomosis in laparoscopic distal gastrectomy for gastric cancer.Methods A case-control study was conducted to retrospectively analyze the clinical data of 110 patients who underwent laparoscopic distal gastrectomy for gastric cancer at the General Hospital of Huainan Oriental Hospital Group from January 2021 to December 2022.According to the different methods of gastrointestinal reconstruction after distal gastrectomy,the patients were divided into an observation group(n=61)and a control group(n=49).The observation group was treated with Roux-en-Y anastomosis,while the control group received Billroth II anastomosis.The intraoperative blood loss,operation time,postoperative recovery,early postoperative ambulation time,time to first flatus,food intake,length of hospital stay,and complications were compared between the two groups.Results The operation time in the control group was(140.0±31.5)minutes,which was significantly shorter than that in the observation group[(180.0±30.5)minutes,t=6.37,P<0.05].There were no statistically significant differences in intraoperative blood loss and early postoperative ambulation time between the two groups(both P>0.05).In the control group,there were 8 cases of alkaline reflux gastritis(16.3%),3 cases of afferent loop obstruction(6.1%),and 3 cases of dumping syndrome(6.1%).These proportions were significantly higher than those in the observation group,which reported 2 cases of alkaline reflux gastritis(3.3%),1 case of afferent loop obstruction(1.6%),and 1 case of dumping syndrome(1.6%)(χ ^(2)=6.15,4.54,4.54,all P<0.05).Conclusion Using Roux-en-Y anastomosis for gastrointestinal reconstruction in patients undergoing laparoscopic distal gastrectomy for gastric cancer can help prevent against alkaline reflux gastritis,afferent loop obstruction,and dumping syndrome;however,it results in a longer surgical time compared with Billroth II anastomosis.

关 键 词：胃肿瘤 腹腔镜检查 胃切除术 胃肠吻合术 吻合术 Roux-en-Y 手术后并发症 胃切除术后综合征 

分 类 号：R735.2[医药卫生—肿瘤]