Roux-en-Y吻合在远端胃癌根治术后消化道重建的应用

Application value of Roux-en-Y anastomosis after distal gastrectomy for gastric cancer

目的 探讨Roux-en-Y吻合术式应用于远端胃癌根治术的临床效果.方法 回顾性分析2010年1月～2012年3月在嵊州市人民医院接受根治性胃大部切除术的患者84例,按消化道重建方式分为Billroth-Ⅱ术44例（BⅡ组）,Roux-en-Y术式40例（RY组）.比较两组患者吻合术相关的并发症及术后1年电子胃镜检查结果.结果 BⅡ组和RY组患者术后并发症发生率分别为18％（8/44）和15％（6/40）,经比较差异无统计学意义（x2=4.016,P=0.134）.术后1年电子胃镜检查显示BⅡ组反流性食管炎发生率亦高于RY组,差异有统计学意义（x2=6.407,P=0.011）,BⅡ组残胃炎发生率高于RY组,差异有统计学意义（x2=17.166,P=0.000）.结论 Roux-en-Y吻合术式应用于远端胃癌根治术能有效地预防反流性食管炎及残胃炎的发生,对提高患者生活质量有所裨益.

Objective To investigate the clinical value of Roux-en-Y reconstruction after distal gastrectomy for gastric cancer.Methods The clinical records of 84 patients who received distal gastrectomy in Shengzhou People＇s Hospital from January 2010 to March 2012 were reviewed.The patients were divided into two groups according the anastomosis methods,44 patients in B Ⅱ group were treated with Billroth-Ⅱ anastomosis and 40 cases in RY group were treated with Roux-en-Y anastomosis.The clinical and following-up data,including complications,gastroscopy result of 1 year,were compared between the two groups.Results The complications rate of B Ⅱ group and RY group were 18% （8/44）,15% （6/40）,the difference was not statistically significant （x2 =4.016,P =0.134）.The occurrence rate of reflux esophagitisgastroscopy in B-Ⅱ group 1 year after the operation according to the electronic gastroscope was higher than that in RY group,the difference was statistically significant （x2 =6.407,P =0.011）; the occurrence rate of residual gastritis in B-Ⅱ group was higher than that in RY group,the difference was statistically significant （x2 =17.166,P =0.000）.Conclusion The application of Roux-en-Y anastomosis in distal gastrectomy for gastric cancer can prevent the occurrence of reflux esophagitis and gastritis residues,it can also improve the patients＇quality of life.