腹腔镜辅助毕Ⅱ式与Roux-en-Y消化道重建的临床疗效分析

Comparison between laparoscopic billroth II and Roux-en-Y reconstruction following distal gastrectomy for gastric

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.