残胃-空肠Roux-en-Y吻合术在远端胃癌根治术中的应用

Application of Roux-en-Y Gastroje Junostomy After Radical Gastrectomy for Distal Gastric Cancer

目的探讨远端胃癌根治术后行残胃-空肠Roux-en-Y(R-Y)吻合的适用情况及其有效性、安全性和经济性。方法选取胃癌患者84例,根据消化道重建方式的不同分为Roux-en-Y(R-Y)组(n=38)和毕Ⅰ(BillrothⅠ)组(n=46),对比分析两组患者的一般情况、术中情况、术后恢复情况、术后并发症的发生情况及住院总费用。结果与毕Ⅰ式组相比,R-Y组患者肿瘤体积较大、侵润程度较深、分期较晚,手术时间较长,留置腹腔引流管时间较长,住院费用较高,残胃炎的发生率较小,但进食后腹胀却高于毕Ⅰ式组(P<0.05)。结论R-Y吻合术与毕Ⅰ式吻合术相比各有利弊,当患者肿瘤体积较大、侵润较深、分期较晚时,为更好的达到根治的目的,宜选用R-Y吻合术进行消化道重建。

Objective To explore the suitable situation,effectiveness,safety and economy of Roux-en-Y gastrojejunostomy after radical gastrectomy for distal gastric cancer.Methods 84 patients with gastric cancer were selected and divided into Roux-en-Y(R-Y)group(n=38)and BillrothⅠgroup(n=46)on the basis of different types of the digestive tract reconstruction.Comparative analysis of the general conditions,Intraoperative situation,postoperative outcomes,postoperative complications,and the total cost between two groups.Results Compared with the BillrothⅠgroup,patients in R-Y group had larger tumor volume,deeper tumor infiltrate and latter tumor stage.They also had longer operative time,longer time keeping with peritoneal drainage pipes,higher hospitalization expenses and lower incidence of inflammation of gastric relict,but most patients in R-Y group have abdominal distension(P<0.05).Conclusion Compared with R-Y anastomosis and BillrothⅠanastomosis,they each have advantages anddisadvantages.When patients with larger tumor volume,deeper tumor infiltrate and latter tumor stage,to achieve the better purpose of cure,appropriate chooses R-Y anastomosis for gastrointestinal reconstruction.