Billroth-Ⅱ与Roux-en-Y重建消化道对高龄胃癌患者术后中长期生存质量的影响

The Long-Term Quality of Life after Billroth-Ⅱand Roux-en-Y Reconstruction in Elderly Patients with Gastric Cancer

目的:探讨Billroth-Ⅱ与Roux-en-Y术式重建消化道对高龄患者远期生存质量的影响。方法:122例70岁以上行远端胃癌根治术患者,采用毕-Ⅱ术式的65例作为毕-Ⅱ组、采用R-Y术式的57例作为R-Y组;于消化道重建术后1年,比较2组患者胃肠道症状评分、吻合口2 cm处的胃炎程度、生活质量(QOL)评分、营养风险指数(NRI)及血清转铁蛋白(TFN)、前白蛋白(PA)、血浆白蛋白(ALB)水平;采用Logistic多变量回归分析患者术前体质量指数(BMI)、肿瘤位置、重建方式及吻合方式对术后发生胃肠道症状风险的影响因素。结果:术后1年2组患者胃肠道症状评分、NRI及血清TFN、PA、ALB水平比较,差异无统计学意义(P>0.05);R-Y组患者吻合口2 cm处重度胃炎发生率(38.6%)显著低于毕-Ⅱ组(56.9%)、QOL评分显著高于毕-Ⅱ组,差异有统计学意义(P<0.05);Logistic多变量回归分析显示,术前BMI(<25 kg/m 2、≥25 kg/m 2)、肿瘤位置(胃窦、胃体)、重建方法(毕-Ⅱ、R-Y)及吻合方式(手工、器械)均不是影响术后发生胃肠道症状风险的独立因素。结论:行远端胃癌根治术的高龄患者,R-Y术式的中长期疗效优于毕-Ⅱ术式。

Objective:To evaluate the long-term quality of life(QOL)after Billroth-Ⅱ(B-Ⅱ)and Roux-en-Y(RY)reconstruction in elderly patients with gastric cancer.Methods:From Jan 2014 to Dec 2017,122 elderly patients with radical distal gastrectomy(DG)(>70 years old)were randomly allocated to B-Ⅱand R-Y groups.The gastrointestinal symptoms score,endoscopic biopsy of anastomotic,gastritis nutritional status and QOL after surgery were compared and evaluated between the 2 procedures 1 year after digestive tract reconstruction.Results:In terms of overall GI symptoms scores,there was no statistically significant difference between B-Ⅱ(1.37±2.02)and R-Y reconstruction(1.14±1.65,P>0.05).Multivariable analysis was also performed using a Logistic regression model to assess the effects of the risk factors of the gastrointestinal symptoms 1 postoperative year after surgery.Multivariable analysis showed that neither B-Ⅱnor R-Y reconstruction was the independently associated factor with the incidence of gastrointestinal symptoms.In terms of nutritional status,there was also no difference in NRI,TFN,PA and ALB.There was significant difference in moderate to severe gastritis by biopsy between B-Ⅱand R-Y patients(56.9%vs 38.6%,P<0.05).The QOL in B-Ⅱpatients was lower than that in R-Y patients 1 year after surgery(P<0.05).Conclusions:B-Ⅱand RY are similar in terms of overall GI symptom scores and nutritional status 1 year after distal gastrectomy.R-Y patients show higher QOL than B-Ⅱpatients.For elderly patients with gastric cancer,RY might be a better choice of operation.