毕Ⅰ式与毕Ⅱ式吻合术应用于根治性远端胃切除术的疗效分析

目的通过比较分析胃癌行胃大部切除术后行毕Ⅰ式和毕Ⅱ式重建术后观察并发症的发生情况,探讨其原因及防治原则。方法选择本院2007年4月-2009年7月检出的200例胃癌患者按毕Ⅰ式和毕Ⅱ式胃大切术后分组,并统计并发症的发生情况进而进行回顾性分析。结果残胃病变的发生率在胃大部切除术后行毕Ⅰ式和毕Ⅱ式后高达93.5%,其中胆汁反流在毕I式术后的发生率为17.9%,明显低于毕Ⅱ式术后的发生率69.2%,毕I式术后残胃原发癌、残胃及吻合口炎的发生率分别为5.9%、44.8%,均显著低于毕Ⅱ式术后的36.1%和77.4%的发生率;残胃及吻合口溃疡在毕I式术后的发生率为23.9%,明显高于毕Ⅱ式术后的59.4%(P<0.01);在两组中其余残胃病变的比较差异无统计学意义(P>O.05)。结论胃大部切除术是治疗胃恶性肿瘤的主要方法,毕I式术后发生并发症的概率要远低于毕Ⅱ式;防治残胃病变尤其是残胃癌,复查内镜及病理是重要措施。

Objective To investigate the complication of Billroth I and Billroth Ⅱ methods on the gastric cancer to discuss the causes and prevention. Methods 200 cases of patients with gastric cancer in our hospital,who were detected between 2007 and 2009,were grouped by Billroth I and Billroth II,and were retrospectively analyzed from the aspects of complication. Results The incidence of gastric stump lesion was as high as 93.5%.The incidence of anastomotie,bile reflux in patients with Billroth I was 17.9% apparently lower than 69.2% with Billroth Ⅱ .The incidences of cancer of the remnant stomach and anastomotie and gastritis of the remnant stomach and were 5.9%, 44.8% in patients with Billroth I, and were apparently lower than Billroth Ⅱ （36.1%, 77.4%）.The incidence of ulcer of the remnant stomach and anastomotic was 59.4% in patients with Billroth 1I ,and was 23.9% in patients with Billroth I （P〈0.01）. There were no significant differences found between the other gastric stump lesion of Billroth I and Billroth II （P〉0.05）. Conclusion The subtotal gastrectomy was the main treatment methods of gastric malignant tumor,peptic ulcer and severe complications. The complications are more in patients with Billroth II than Billroth I. Periodical reexamination for the patients who underwent partial gastrectomy by endoscopy with multiple biopsies is the important measure for detecting gastric stump lesion, and especially for gastric stump cancer.