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目的:探讨胃癌远端胃大部切除后行B-II+Braun或Roux-en-Y两种消化道重建方式的优缺点。方法:回顾性分析我院2010年1月至2013年1月间接受远端胃大部切除并行上述消化道重建的胃癌患者临床及随访资料,据消化道重建方式分为B-II+Braun和Roux-en-Y两组,按性别、年龄、肿瘤大小、肿瘤分期进行配比,比较两组患者手术相关指标(手术时间、术中出血量、术后首次排气时间、术后住院时间)、术后近、远期并发症、术后1年以上胃镜复查结果及术后生存率。结果:两组手术相关指标、术后近期并发症、术后1年和3年生存率差异均无统计学意义(均P>0.05)。远期并发症中,B-II+Braun组烧心/返流、倾倒综合征的发生率(分别为20.83%、16.67%)显著高于Roux-en-Y组(均为4.17%),差异有统计学意义(P<0.05)。术后1年以上内镜检查结果显示Roux-en-Y组反流性胃炎、胆汁反流及反流性食管炎发生率(分别为31.25%、18.75%、9.38%)显著低于B-II+Braun组(分别为72.22%、61.11%、36.11%),差异有统计学意义(P<0.05);食物潴留方面,两组差异无统计学意义(P>0.05)。结论:胃癌远端胃大部切除术后行Roux-en-Y重建术后抗返流效果显著优于B-II+Braun,且在手术安全性及术后生存率方面无明显劣势。前者可替代后者,值得在临床推广应用。
Objective: To investigate the advantages and disadvantages of two kinds of digestive reconstruction methods of B-II + Braun or Roux-en-Y after distal gastrectomy of gastric cancer. Methods: The clinical and follow-up data of patients with gastric cancer undergoing distal gastrectomy and concurrent gastrointestinal reconstruction from January 2010 to January 2013 in our hospital were retrospectively analyzed. According to the mode of digestive tract reconstruction, B-II + Braun and Roux-en-Y groups were compared according to sex, age, tumor size and tumor stage. The operation-related indexes (operative time, intraoperative blood loss, first postoperative exhaust time, postoperative hospital stay) , Postoperative short-term and long-term complication, postoperative gastroscopy review and postoperative survival rate more than one year. Results: There was no significant difference between the two groups in the indexes of operation, recent postoperative complications, postoperative 1 year and 3 year survival rates (all P> 0.05). Among long-term complications, the incidence of heartburn / reflux and dumping syndrome in B-II + Braun group was significantly higher than Roux-en-Y group (20.83%, 16.67%, 4.17% respectively) Statistical significance (P <0.05). The results of endoscopy more than one year after operation showed that the incidences of reflux gastritis, bile reflux and reflux esophagitis in Roux-en-Y group were significantly lower than those in B-II group (31.25%, 18.75% and 9.38% respectively) + Braun group (72.22%, 61.11%, 36.11% respectively) (P <0.05). There was no significant difference between the two groups in food retention (P> 0.05). Conclusion: The anti-reflux effect of Roux-en-Y reconstruction after distal gastrectomy of gastric cancer is better than that of B-II + Braun, and there is no obvious disadvantage in the safety and postoperative survival rate. The former can replace the latter, it is worth in the clinical application.