不同消化道重建方式对行远端胃癌切除患者术后恢复的影响

Effect of different types of digestive reconstruction on the postoperative recovery of patients with gastric cancer treated by distal gastrectomy

目的探讨不同消化道重建方式对行远端胃癌切除术患者术后恢复的影响。方法选取胃癌行远端胃大部切除术患者76例,随机分为A、B组,各38例。A组行BillrothⅡ式吻合术重建消化道,B组行Roux-en-Y吻合术重建消化道。观察2组近、远期并发症发生情况、手术情况、术后1年生存率(1-y OS)和3年生存率(3-y OS)、术后1年反流性食管炎、胆汁反流及反流性胃炎发生率。结果 B组反流、胃倾倒症的发生率低于A组,差异有统计学意义(P<0.05);B组手术时间长于A组,差异有统计学意义(P<0.01);2组中位随访时间及1-y OS、3-y OS差异均无统计学意义(P>0.05);B组反流性食管炎、胆汁反流、反流性胃炎发生率均低于A组,差异有统计学意义(P<0.01)。结论 Roux-en-Y吻合术用于远端胃大部切除术患者能够有效预防反流性疾病的发生,提高患者长期生活质量。

Objective To investigate the effect of different types of digestive reconstruction on the postoperative recovery of patients with gastric cancer undergoing distal gastrectomy. Methods Seventy-six patients with gastric cancer who underwent distal subtotal gastrectomy were randomly assigned into groups A and B, with38 cases in each group. For digestive reconstruction, the patients in group A received Billroth Ⅱ anastomosis, while those in group B received Roux-en-Y anastomosis. The incidence of short-term and long-term complications, operation condition, postoperative 1-year o- verall survival （ 1 -y OS） and 3-year overall survival （3-y OS） as well as incidence of reflux esophagi- tis, bile reflux and reflux gastritis were all observed in two groups. Results The incidence of reflux and dumping syndrome was lower, whereas the operation time was longer in group B than in group A, and the differences were statistically significant （P 〈 0.05 or P 〈 0.01 ）. There was no statistical sig- nificance between two groups by comparison to the median follow-up time, 1-y OS and 3-y OS （ P 〉 0.05 ）. The incidence of reflux esophagitis, bile reflux and reflux gastritis in group B was lower than that in group A, and the difference was statistically significant （P 〈 0.01 ）. Conclusion For the pa- tients undergoing distal subtotal gastrectomy, Roux-en-Y anastomosis can effectively prevent the oc- currence of reflux diseases, and improve the long-term quality of life.