远端胃癌根治术后不同消化道重建手术对肠道菌落的影响

Effect of different digestive tract reconstruction operations on intestinal colonies after distal gastrectomy

目的探讨远端胃癌根治术后不同消化道重建手术对肠道菌落的影响。方法回顾性分析笔者医院收治的102例行远端胃癌根治术后消化道重建手术患者的临床资料,按术式不同分为A组(31例,行BillrothⅠ术)、B组(35例,行BillrothⅡ术)、C组(36例,行非离断式Roux-en-y术),比较3组术后肠道菌落数量、并发症、Visick分级等情况。结果术后3个月,C组Visick分级、排气和肠鸣音恢复时间<48 h、排便时间48~72 h占比明显优于A、B组(P<0.05),术后肠道菌落数量变化幅度及并发症发生率明显低于A、B组(P<0.05);而A、B两组间上述指标比较无显著差异(P>0.05)。结论非离断式Roux-en-y术克服了传统吻合术术后并发症较多的弊端,有利于改善肠道菌群失衡和术后恢复,是远端胃癌根治术后较理想的消化道重建术式。

Objective To explore the effects of different digestive tract reconstruction operations on intestinal colonies after distal gastrectomy. Methods The clinical data of 102 patients to receive digestive tract reconstruction operations after distal gastrectomy in our hospital were analyzed retrospectively. They were divided into three groups according to the different surgical methods, i.e., group A（n=31, Billroth I）, group B（n=35, Billroth Ⅱ）, and group C（n=36, non-mutilation Roux-en-y）, and the number of intestinal colonies, complications, and Visick classification and so on were compared among the three groups. Results Three months after the operation, the Visick classification and the ratios of exhaust and enteric sound recovery time in group C within 48 h and defecation time within 48-72 h were significantly better than those in group A and B（P〈0.05）, and the range of variation in intestinal colonies and the incidence of complications after the operation were significantly lower than those in group A and B（P〈0.05）, but there was no significant difference in the above indexes between group A and B（P〉0.05）. Conclusion Non-mutilation Roux-en-y can overcome the disadvantages of many complications after traditional anastomosis, improve the imbalance of intestinal flora and recovery after operation. It is an ideal method for the reconstruction of digestive tract after distal gastrectomy.