远端胃癌D2根治术Billroth-Ⅰ式、Billroth-Ⅱ式和Roux-en-Y式重建的术后恢复效果比较

Comparison of postoperative recovery effects of Billroth-Ⅰ, Billroth-Ⅱ and Roux-en-Y reconstruction in D2 radical gastrectomy for distal gastric cancer

目的比较远端胃癌D2根治术Billroth-Ⅰ式、Billroth-Ⅱ式和Roux-en-Y式重建的术后恢复效果。方法将2014年1月至2018年12月收治的60例远端胃癌D2根治术患者以简单随机化法分为A、B、C组,每组20例。A组接受术后Billroth-Ⅰ式消化道重建,B组接受术后Billroth-Ⅱ式消化道重建,C组接受术后Roux-en-Y式消化道重建。比较三组远端胃癌患者的术后恢复效果。结果C组手术出血量多于A组和B组,手术用时长于A组和B组,下床活动时间、术后拔管时间长于A组(P<0.05);B组手术用时、术后排气时间、术后进食时间、术后拔管时间长于A组(P<0.05)。C组的并发症总发生率明显低于A组和B组(P<0.05)。C组反酸烧心感评分明显高于A组和B组(P<0.05)。结论远端胃癌D2根治术患者术后接受Billroth-Ⅰ式、Billroth-Ⅱ式和Roux-en-Y式消化道重建,均具有一定的价值,其中Roux-en-Y式重建虽然用时较长,但并发症发生率低,可有效控制病情。

Objective To compare the postoperative recovery effects of Billroth-Ⅰ,Billroth-Ⅱand Roux-en-Y reconstruction in D2 radical gastrectomy for distal gastric cancer.Methods From January 2014 to December 2018,60 patients with distal gastric cancer undergoing D2 radical operation were divided into group A,group B and group C by simple randomization method,with 20 cases in each group.The group A received postoperative Billroth-Ⅰdigestive tract reconstruction,the group B received postoperative Billroth-Ⅱdigestive tract reconstruction,and the group C received postoperative Roux-en-Y digestive tract reconstruction.The postoperative recovery effects of patients with distal gastric cancer of the three groups were compared.Results The blood loss volume of the group C was more than that of the group A and the group B,the operation time was longer than that of the group A and the group B,the time of getting out of bed and extubation were longer than those of the group A(P<0.05);the operation time,postoperative exhaust time,postoperative eating time and extubation time of the group B were longer than those of the group A(P<0.05).The total incidence of complications in the group C was significantly lower than that in the group A and the group B(P<0.05).The score of acid regurgitation and heartburn in the group C was significantly higher than that in the group A and the group B(P<0.05).Conclusion Billroth-Ⅰ,Billroth-Ⅱand Roux-en-Y digestive tract reconstruction are valuable for patients with distal gastric cancer after D2 radical gastrectomy.Roux-en-Y reconstruction takes a long time,but has low incidence of complications,which can effectively control the disease.