Roux-en-Y式吻合和Billroth-Ⅱ式吻合对腹腔镜远端胃切除术患者肠道菌群和胆囊功能的影响

Effects of Roux-en-Y anastomosis and Billroth-Ⅱanastomosis on intestinal flora and gallbladder function in patients underwent laparoscopic distal gastrectomy

目的对比分析Billroth-Ⅱ式吻合与Roux-en-Y式吻合对腹腔镜远端胃切除术(LDG)患者肠道菌群和胆囊功能的影响。方法选取行LDG的患者98例,采用随机数字表法将其分为B-Ⅱ组和R-Y组,每组49例,B-Ⅱ组采用Billroth-Ⅱ式吻合进行消化道重建,R-Y组采用Roux-en-Y式吻合进行消化道重建。比较2组患者肠道菌群分布情况、胆囊收缩功能及随访结果。结果2组患者术后肠杆菌和肠球菌的数量较术前增多(P<0.05),而乳酸杆菌和双歧杆菌的数量较术前减少(P<0.05),且R-Y组肠道菌群的数量变化幅度小于B-Ⅱ组(P<0.05)。术后6个月时,B-Ⅱ组胆囊容积及血清CCK水平较术前升高(P<0.05),胆囊排空率较术前下降(P<0.05),R-Y组胆囊容积、胆囊排空率及血清CCK水平较术前无变化(P>0.05),但R-Y组胆囊容积及血清CCK水平低于B-Ⅱ组(P<0.05),胆囊排空率高于B-Ⅱ组(P<0.05)。术后1年,R-Y组残胃炎、残胃溃疡、反流性食管炎及胆囊结石的发生率低于B-Ⅱ组(P<0.05)。结论LDG术中采用Roux-en-Y式吻合不仅有助于改善患者肠道菌群失衡,促进患者胆囊收缩功能恢复,还能有效降低术后残胃及食管相关并发症和胆囊结石的发生率,提高手术安全性。

Objective To compare and analyze the effects of Billroth-Ⅱanastomosis and Roux-en-Y anastomosis on intestinal flora and gallbladder function in patients underwent laparoscopic distal gastrectomy(LDG).Methods A total of 98 patients who underwent LDG were selected and divided into the B-Ⅱgroup and the R-Y group by random number table method,with 49 cases in each group.The B-Ⅱgroup used Billroth-Ⅱanastomosis for digestive tract reconstruction,and the R-Y group used Roux-en-Y anastomosis for digestive tract reconstruction.The distribution of intestinal flora,gallbladder contraction function and follow-up results in the two groups were compared.ResultsThe numbers of enterobacteria and enterococcus in the two groups after surgery increased compared with those before surgery(P<0.05),while the numbers of lactobacillus and bifidobacteria after surgery decreased compared with those before surgery(P<0.05),and the change range in the number of intestinal flora in the R-Y group was smaller than that in the B-Ⅱgroup(P<0.05).At 6 months after surgery,the gallbladder volume and serum CCK level of the B-Ⅱgroup were higher than those before surgery(P<0.05),and the gallbladder emptying rate was lower than that before surgery(P<0.05);the gallbladder volume,gallbladder emptying rate and serum CCK level of the R-Y group were not changed compared with those before surgery(P>0.05);the gallbladder volume and serum CCK level in the R-Y group were lower than those in the B-Ⅱgroup(P<0.05),the gallbladder emptying rate was higher than that in the B-Ⅱgroup(P<0.05).The incidence of residual gastritis,residual gastric ulcer,reflux esophagitis and gallstone in the R-Y group 1 year after surgery was significantly lower than that in the B-Ⅱgroup(P<0.05).Conclusion Roux-en-Y anastomosis during LDG can not only help to improve the imbalance of intestinal flora in patients,promote the recovery of gallbladder contraction function,but also effectively reduce the incidence of postoperative residual stomach and esophageal related complications and gallstones,and improve the safety of surgery.