不同消化道重建术式对胃癌患者远端胃切除术后生存质量的影响

Effect of Different Digestive Tract Reconstruction Methods on the Quality of Life after Distal Gastrectomy in Patients with Gastric Cancer

目的探讨应用不同消化道重建术式的胃癌远端胃切除手术对于患者恢复及生存质量的影响。方法108例患者随机分为3组:BillrothⅠ式吻合组(B-Ⅰ组),BillrothⅡ式联合Braun吻合组(B-ⅡB组),Roux-en-Y吻合组(Roux组)。比较其手术相关指标、术后的恢复和预后情况。结果3组各有36例患者纳入研究,其一般情况无统计学差异(均P>0.05);手术相关指标中B-Ⅰ组手术时间短于B-ⅡB组和Roux组(P=0.016);术后恢复指标中,术后胃瘫发生率B-Ⅰ组高于其他两组(P=0.030),住院总费用B-Ⅰ组少于其他两组(P=0.007)。随访时间5~40个月(平均28.8个月),3组患者在30 d内再入院率、总生存率、无瘤生存率和生存质量方面的比较,均无统计学意义(均P>0.05)。结论Ⅱ~Ⅲ期胃癌远端胃切除手术中,Roux-en-Y吻合和BillrothⅡ式联合Braun吻合的医疗花费稍高于BillrothⅠ式吻合,但术后短期恢复具有一定优势。

Objective To explore the effect of different gastrointestinal reconstruction techniques on distal gastrectomy for gastric cancer patients.Methods Eligible patients were randomly divided into three groups,Billroth I group(B-Ⅰgroup,n=36),BillrothⅡcombined with Braun anastomosis group(B-ⅡB group,n=36),and Roux-en-Y anastomosis group(Roux group,n=36).General data,surgery-related indicators,postoperative recovery and prognosis were compared among the three groups.Results The general data were comparable among the three groups with no difference(all P>0.05).In the surgical-related indicators,only operation time of B-Ⅰgroup was statistically shorter than the others(P=0.016);in the postoperative recovery indicators,the incidence of gastroparesis of B-Ⅰgroup was significantly higher(P=0.030)and total medical costs of B-Ⅰgroup was significantly lower(P=0.007).The average postoperative follow-up was 28.8 months(range 5~40 months).There were no significant differences in the hospital readmission rate,overall survival and QoL among these three groups(all P>0.05).Conclusion In the different gastrointestinal reconstruction techniques after distal gastrectomy for stageⅡtoⅢgastric cancer,the medical cost of Roux-en-Y and BillrothⅡcombined Braun anastomosis is slightly higher than that of BillrothⅠ,but their short-term postoperative recovery has certain advantages.