远端胃癌根治术行Billroth Ⅰ和改良Billroth Ⅱ消化道重建后生存质量分析

Analysis of digestive tract reconstruction in BillrothⅠand modified BillrothⅡ after the distal gastrectomy for gastric carcinoma

目的:探讨胃癌患者行远端胃大部切除术后行BillrothⅠ式和改良BillrothⅡ式消化道重建的疗效。方法:回顾性分析2016年度哈尔滨医科大学附属肿瘤医院胃肠外科收治的451例胃癌患者的临床资料及随访结果,按吻合方式分为B-Ⅰ组(99例行B-Ⅰ式吻合)和B-Ⅱ组(352例行改良B-Ⅱ式吻合),比较患者的围术期、术后早期并发症及远期症状(1年以上)的情况。结果:两组患者间性别、年龄和体重指数(body mass index,BMI)比较无统计学差异。围术期:B-Ⅰ组患者的肿瘤临床分期早于B-Ⅱ组(Ⅰ期胃癌,56. 6%> 35. 2%),肿瘤直径小于B-Ⅱ组(3. 58±1. 54 <4. 88±2. 37) cm,手术时间短于B-Ⅱ组(154. 68±41. 86<171. 48±32. 69) min,术后首次排气时间长于B-Ⅱ组(116. 14±17. 70> 110. 38±18. 98) min,组间比较存在统计学差异(P <0. 05);术后正常进半流食时间无明显差异(P> 0. 05)。术后早期并发症:所有患者术后早期胃无力、吻合口出血等并发症的发生率不足5%,两组患者间分别比较均无明显统计学差异(P> 0. 05)。术后远期症状:B-Ⅱ组患者倾倒综合征等表现的发生率高于B-Ⅰ组(9. 4%> 3. 0%),消化道反流症状发生率低于B-Ⅰ组(6. 8%<17. 2%),组间比较均存在统计学差异(P <0. 05);其他如消瘦、腹胀等症状及残胃吻合口病变方面两组间比较无统计学差异(P> 0. 05)。结论:与B-Ⅰ式相比,改良B-Ⅱ式术后胆汁反流及相关并发症的发生率较低,患者生存质量较高。

Objective:To investigate the effect of BillrothⅠand modified BillrothⅡdigestive tract reconstruction after distal gastrectomy for gastric cancer patients.Methods:Clinical data and follow-up results of 451 patients,who underwent radical gastectomy for gastric cancer in gastroenterological surgery of Harbin Medical University Cancer Hospital in 2016,were analyzed retrospectively.All patients was divided into group B-Ⅰ(99 patients with B-Ⅰanastomosis)and group B-Ⅱ(352 patients with modified B-Ⅱanastomosis)as reconstruction modes.Perioperative condition,postoperative early complications and long-term clinical symptoms between the two groups were compared.Results:There was no statistically significant difference in gender,age and body mass index(BMI)between the two groups.In the perioperative period,the patients in group B-Ⅰwere in an earlier clinical stage of tumor(primary gastric cancer,56.6%)than group B-Ⅱ(35.2%).And the patients in group B-Ⅰhad smaller tumor by diameter(3.58±1.54<4.88±2.37)cm,shorter operation time(154.68±41.86<171.48±32.69)min,later postoperative anal flatus by time(116.14±17.70>110.38±18.98)min than those in group B-Ⅱ,significant difference existed between the two groups(P<0.05).But the first oral feeding time(129.62±33.30>123.96±52.07)min had no significant difference(P>0.05).As for postoperative early complications,the incidences of gastric weakness,anastomotic bleeding,lymphatic leakage and ileus in the two groups were less than 5%,there was no significant difference between the two groups(P>0.05).In terms of postoperative long-term symptoms,the incidence of dumping syndrome in the two groups was 3%and 9.4%,respectively,and the incidence of bile reflux was 17.2%and 6.8%,respectively.There were significant differences between the two groups(P<0.05).There were no significant differences in other symptoms such as emaciation,abdominal distention and gastric remnant anastomosis(P>0.05).Conclusion:Compared with B-Ⅰoperation,modified B-Ⅱoperation can reduce bile reflux and related complications to improve the life quality of the patients.