摘要
目的:探究腹腔镜辅助毕Ⅱ式对比Roux-en-Y远端胃癌根治术后消化道重建临床疗效。方法 :纳入2014年1月—2015年6月确诊为远端胃癌的186例患者,随机分为RY组、毕Ⅱ组各93例。对两组患者临床指标、并发症进行比较,并绘制生存曲线图比较两种术式消化道重建后患者的总生存期。结果:腹腔镜辅助下毕II式消化道重建术在手术时间(t=4.711,P=0.001)、术中出血量(t=8.18,P〈0.001)方面优于RY组,但在淋巴结清除数目(t=0.428,P=0.674),术后排气时间(t=1.874,P=0.079),住院时间(t=1.538,P=0.144)及免疫学指标方面两者差异无统计学意义(P〉0.05)。通过对术后并发症的分析发现,毕Ⅱ式较Roux-en-Y式可明显降低患者的肺部感染率(χ~2=2.581,P=0.01),但术后切口感染(χ~2=0.58,P=0.56)方面两者差异无统计学意义。术后随访1年,在肠梗阻(χ~2=1.55,P=0.12)、吻合口瘘(χ~2=1.356,P=0.175)及胃无力(χ~2=0.384,P=0.701)等的发生率方面,两组患者差异无统计学意义(P〉0.05)。绘制生存曲线图进行比较,两组患者的总生存期差异无统计学意义(χ~2=0.320,P=0.572)。结论:腹腔镜辅助下毕Ⅱ式消化道重建术与Roux-en-Y相比,具有手术时间短、术中出血量少、术后肺部感染率低等优点,但不能明显降低患者远期并发症、改善患者的免疫功能及总生存期。还需进一步多中心、大样本的随机对照试验验证。
Objective: To explore the effects of Billroth II anastomosis and Roux-en-Y anas- tomosis for the treatment of patients with distal gastric cancer. Methods: A total of 186 distal gastric cancer patients who received their digestive tract reconstruction after distal gastrectomy were randomized into Billroth II group(B2 group) and Roux-en-Y group(RY group). Following the operation, clinical outcomes, complications and overall survival (OS) were evaluated. Results: Compared with RY anastomosis, B2 anastomosis can significantly reduce the operative time(t=4.711, P=0.001 ), blood loss (t=8.18, P〈0.001)and the rate of pulmonary infection (χ2=2.581, P=0.01). However, there are non-significant differences in long-term complication,immunal state and OS(χ2=0.320, P=0.572). Conclusion: Although laparoscopic Billroth II anastomosis is more superior than Roux-en-Y anastomosis in reducing the operative time, blood Iossand the rate of pulmonary infection, both techniques should be regarded as equally acceptable reconstructive options following distial gastrectomy for gastric cancer.
出处
《中国现代普通外科进展》
CAS
2016年第11期866-869,共4页
Chinese Journal of Current Advances in General Surgery