根治性远端胃切除术后三种重建方式的对照研究

Comparison of three types of reconstruction after radical distal gastrectomy for gastric cancer

目的介绍一种新的根治性远端胃切除术后胃空肠吻合方式，并与传统Billroth Ⅱ式吻合和Roux—enY吻合的中短期效果进行对比研究。方法回顾性分析2007年1月至2009年9月河南省肿瘤医院普外科137例因胃窦癌行根治性远端胃切除术患者的临床资料，其中46例接受改良Billroth Ⅱ式吻合，50例接受传统Billroth Ⅱ式吻合，41例采用Roux～enY吻合。比较三组患者总手术时间、消化道重建手术时间、手术并发症、住院费用、住院时间及倾倒综合征的发生率，并进行术后胃癌患者生活质量调查问卷（Quality of Life Questionnaire of Stomach 22，QLQ—ST022）评分。随访率为96．4％，随访时间分别为1个月、6个月及1年。结果改良BillrothⅡ式吻合组的消化道重建手术时间为（15±6）min，较其他两组[（26±16）min，（32±17）min）]明显缩短，差异有统计学意义（P〈0．05），而总手术时间、术后并发症发生率，住院费用、住院时间等比较差异无统计学意义（P〉0．05）。生活质量评估中呃逆和饮食受限两项明显优于其他两组。结论改良Billroth Ⅱ式吻合具有手术时间短、操作简便、术后生活质量好等优点。

Objective To introduce a new method ot gastrojejunostomy in radical distal gastrectomy, and compare the effects with Billroth Ⅱ and Roux - en - Y. Methods Retrospectively analyze the datas of 137 patients underwent radical distal gastrectomy for distal gastric cancer in general surgery of Henan Tumor Hospital. Forty- six cases underwent modified Billroth Ⅱ gastrectomy. Fifty cases used the Billroth Ⅱ method and 41 cases used the Roux - en - Y method. Comparative study the operation complications, hospital expenses, hospital stay, and the complication rate included the dumping syndrome in the 3 groups. While analyzed the Quality of Life Questionnaire of Stomach 22. Follow - up （96.4%） was performed at I month, 6 months and 1 year. Results The gastrojejunostomy time of mod- ified Billroth Ⅱ group were （ 15± 6） rain, while the other two groups were （26±16） min and （3±17） min separately, the differences were significant. The operation time, complications, hospital expenses and time of hospitalization were no significant difference. The modified Billroth Ⅱ group showed a better score in hiccup and drink and food limitation. Conclusions The modified Billroth Ⅱ gastrectomy group has a short gastrojejunostomy time, and better quality of life. It＇s more technically simple.