毕Ⅱ式联合Braun吻合与单纯毕Ⅱ式吻合在全腹腔镜下远端胃癌根治术中的疗效比较

Comparison of Efficacy of Billroth Ⅱ Combining with Braun Anastomosis and Billroth Ⅱ Anastomosis in The Total Laparoscopic Distal Gastrectomy

目的探讨全腹腔镜下远端胃癌根治术中毕Ⅱ式吻合联合Braun吻合的临床疗效。方法回顾性分析笔者所在医院2012年6月至2014年6月期间收治的行全腹腔镜下远端胃癌根治术的186例远端胃癌患者的临床资料,根据术中消化道重建方式分为毕Ⅱ式+Braun吻合组86例和毕Ⅱ式吻合组100例,比较2组患者的临床疗效。结果毕Ⅱ式+Braun吻合组和毕Ⅱ式吻合组患者的手术时间、消化道重建时间、术中出血量、术后排气时间及住院时间比较差异均无统计学意义(P>0.05),而毕Ⅱ式+Braun吻合组的碱性反流性胃炎、十二指肠残端瘘、吻合口炎及术后胃瘫综合征的发生率均低于毕Ⅱ式吻合组(P<0.05)。结论在全腹腔镜下远端胃癌根治术中,毕Ⅱ式联合Braun吻合的应用减少了术后碱性反流性胃炎、十二指肠残端瘘、吻合口炎及术后胃瘫综合征的发生,是改善胃癌患者术后生存质量较理想的手术方式。

Objective To investigate the clinical efficacy and short-term complications of total laparoscopic distal gastrectomy, which adopting Billroth Ⅱ combining with Braun anastomosis. Methods Clinical data of 186 cases of distal gastric cancer who underwent total laparoscopic distal gastrectomy in our hospital from June 2012 to June 2014, including 86 cases who adopted Billroth Ⅱ combining with Braun anastomosis, and 100 cases who adopted Billroth Ⅱ anastomosis. The clinical efficacy was compared between these two groups. Results There was no significant difference in the operation time, digestive tract reconstruction time, intraoperative blood loss, postoperative exhaust time, and hospital stay（P〉0.05）. However, compared with Billroth Ⅱ anastomosis group, the incidence rates of alkaline reflux gastritis, duodenal fistula, anastomositis, and postsurgical gastroparesis syndrome were lower in Billroth Ⅱ combining with Braun anastomosis group（P〈0.05）. Conclusions The application of Billroth Ⅱ combining with Braun anastomosis in total laparoscopic distal gastrectomy could reduce the incidence rates of alkaline reflux gastritis, duodenal fistula, anastomositis, and postsurgical gastroparesis syndrome, and it is an ideal operation method to improve the quality of life for gastric cancer patients.