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目的探讨根治性远端胃切除术后理想的消化道重建方式。方法回顾性分析2010年1月至2013年1月期间于第四军医大学附属西京消化病医院接受根治性远端胃切除术的862例患者的临床及随访资料,根据消化道重建方式分为Roux-en-Y组、BillrothⅡ式吻合+Braun组(B-Ⅱ+Braun组)及BillrothⅠ式吻合组(B-Ⅰ组),再按性别、年龄(差异<5岁)、肿瘤直径(差异<1 cm)、肿瘤p T分期及肿瘤p N分期为匹配变量,行Gmatch配比以减少组间患者临床病理学特征的差异后,比较3组的围手术期相关指标、术后近期(30 d内)并发症、术后1年以上胃镜复查结果及术后生存情况。结果 1围手术期相关指标。3组患者的手术时间、术后首次进半流食的时间及术后住院时间均不同(P<0.050):B-Ⅰ组的手术时间短于Roux-en-Y组和B-Ⅱ+Braun组(P<0.012 5),但Roux-en-Y组和B-Ⅱ+Braun组比较差异无统计学意义(P>0.012 5);B-Ⅰ组术后首次进半流食的时间较B-Ⅱ+Braun组早(P<0.012 5),但Roux-en-Y组和B-Ⅱ+Braun组比较、Roux-en-Y组和B-Ⅰ组比较差异均无统计学意义(P>0.0125);B-Ⅱ+Braun组和B-Ⅰ组的术后住院时间均短于Roux-en-Y组(P<0.012 5),但B-Ⅱ+Braun组和B-Ⅰ组比较差异无统计学意义(P>0.012 5)。2术后近期并发症。Roux-en-Y组、B-Ⅱ+Braun组及B-Ⅰ组分别发生并发症4例(12.5%,4/32)、2例(6.2%,2/32)及1例(3.1%,1/32),但3组患者的并发症发生率比较差异无统计学意义(P=0.495)。3术后1年以上胃镜复查结果。3组患者的反流性胃炎、胆汁反流及反流性食管炎的发生率均不同(P<0.050):Roux-en-Y组的反流性胃炎、胆汁反流及反流性食管炎发生率均低于B-Ⅱ+Braun组和B-Ⅰ组(P<0.012 5),但B-Ⅱ+Braun组和B-Ⅰ组的反流性胃炎、胆汁反流及反流性食管炎发生率比较差异均无统计学意义(P>0.012 5)。4生存情况。Roux-en-Y组、B-Ⅱ+Braun组及B-Ⅰ组的3年生存率分别为70.0%(21/30)、73.3%(22/30)及75.0%(24/32),且3组患者的生存曲线比较差异无统计学意义(P=0.911)。结论 Roux-en-Y吻合的抗反流效果显著;B-Ⅰ式吻合的操作简单、手术时间短、术后恢复快且最符合生理结构。二者均可在根治性远端胃切除术消化道重建中优先选用。
Objective To explore the ideal method of digestive tract reconstruction after radical distal gastrectomy. Methods The clinical and follow-up data of 862 patients undergoing radical distal gastrectomy from January 2010 to January 2013 at Xijin Digestive Disease Hospital Affiliated to the Fourth Military Medical University were retrospectively analyzed. According to the method of gastrointestinal reconstruction, Roux -en-Y group, Billroth Ⅱ anastomosis + Braun group (B-Ⅱ + Braun group) and Billroth Ⅰ anastomosis group (B-Ⅰ group) cm), tumor p T stage and tumor p N stage as matching variables. The Gmatch ratio was used to reduce the difference of clinicopathological features between the two groups. The perioperative indexes of the three groups were compared. ) Complications, postoperative more than 1 year endoscopy results and postoperative survival. Results 1 Perioperative related indicators. The operation time of the patients in the three groups was significantly different from that of the Roux-en-Y group and the B-Ⅱ + Braun group (P <0.050) (P <0.012 5). However, there was no significant difference between Roux-en-Y group and B-Ⅱ + Braun group (P> 0.012 5) + Braun group (P <0.012 5), but there was no significant difference between Roux-en-Y group and B-Ⅰ group (P> 0.0125) ; The postoperative hospital stay in B-Ⅱ + Braun group and B-Ⅰ group were shorter than those in Roux-en-Y group (P <0.012 5), but there was no significant difference between B-Ⅱ + Braun group and B-Ⅰ group Significance (P> 0.012 5). 2 postoperative complications. 4 cases (12.5%, 4/32), 2 cases (6.2%, 2/32) and 1 case (3.1%) in Roux-en-Y group, B-Ⅱ + Braun group and B-Ⅰ group 1/32), but there was no significant difference in complication rates between the three groups (P = 0.495). 3 more than 1 year after endoscopy results. The incidences of reflux gastritis, bile reflux, and reflux esophagitis were all different among the three groups (P <0.050): reflux gastritis, bile reflux, and reflux esophagitis in the Roux-en-Y group (P <0.012 5), but the incidences of reflux gastritis, bile reflux and reflux esophagitis in B-Ⅱ + Braun group and B-Ⅰ group were lower than those in B-Ⅱ + Braun group and B-Ⅰ group There was no significant difference in the incidence (P> 0.012 5). 4 Survival. The 3-year survival rates of Roux-en-Y group, B-Ⅱ + Braun group and B-Ⅰ group were 70.0% (21/30), 73.3% (22/30) and 75.0% (24/32) There was no significant difference in survival curves between the three groups (P = 0.911). Conclusions The Roux-en-Y anastomosis with anti-reflux effect is significant. The B-Ⅰ anastomosis is simple, the operation time is short, the postoperative recovery is quick and most consistent with the physiological structure. Both may be preferred in the gastrectomy for distal gastrectomy.