胃空肠裤形吻合与BillrothⅡ(BⅡ)式吻合腹腔镜辅助远端胃癌根治术疗效的比较

Comparison of Clinical Efficacy Between Pants-shaped Gastrojejunostomy and BillrothⅡType Anastomosis After Laparoscopic Assisted Distal Gastrectomy

目的比较胃空肠裤形吻合与BillrothⅡ(BⅡ)式吻合腹腔镜辅助远端胃癌根治术的临床疗效。方法回顾性分析2018年7月~2019年5月我科122例腹腔镜远端胃癌根治术的临床资料,其中裤形吻合66例(裤形组),BⅡ式吻合56例(BⅡ组)。采用食物残留、胃炎、胆汁反流(residue,gastritis,bile,RGB)量表与洛杉矶分级标准对术后1、2年胃镜表现进行评估,采用胃肠道生活质量指数(Gastrointestinal Quality of Life Index,GIQLI)对2组患者术后1、2年生活质量进行比较。结果所有患者均顺利完成手术。术后第1年裤形组胃镜下食物残留发生率明显低于BⅡ组(χ^(2)=13.000,P=0.000),胃炎发生率明显低于BⅡ组(χ^(2)=6.393,P=0.011),胆汁反流发生率明显低于BⅡ组(χ^(2)=7.709,P=0.005)。术后第2年裤形组胃镜下食物残留发生率明显低于BⅡ组(χ^(2)=10.095,P=0.001),胃炎发生率明显低于BⅡ组(χ^(2)=4.058,P=0.044),胆汁反流发生率明显低于BⅡ组(χ^(2)=12.374,P=0.000)。裤形组术后第1、2年反流性食管炎发生率明显低于BⅡ组(χ^(2)=4.764,P=0.029;χ^(2)=9.872,P=0.002)。术后第1年裤形组自觉症状、心理情绪状况、社会活动、总分均明显高于BⅡ组[70.0(64.5,72.0)分vs.58.0(58.0,64.3)分,Z=-4.320,P=0.000;15(14,15)分vs.14(13,14)分,Z=-2.926,P=0.003;(10.5±1.3)分vs.(9.3±1.7)分,t=3.904,P=0.000;116.5(108.3,118.8)分vs.103.0(100.0,109.3)分,Z=-4.686,P=0.000]。术后第2年裤形组患者自觉症状、心理情绪状况、总分均明显高于BⅡ组[70.0(62.3,71.8)分vs.58.0(57.5,66.5)分,Z=-3.197,P=0.001;(15.5±2.5)分vs.(14.2±2.0)分,t=2.706,P=0.008;117.0(107.3,121.8)分vs.108.0(104.0,111.0)分,Z=-3.292,P=0.001],社会活动得分明显低于BⅡ组[12(11,12)分vs.14(12,14)分,Z=-4.271,P=0.000]。结论裤形吻合能有效改善远端胃癌术后胆汁反流的问题,提高患者术后生活质量,值得推广。

Objective To compare the clinical efficacy of pants-shaped gastrojejunostomy and BillrothⅡtype anastomosis for digestive tract reconstruction after laparoscopic-assisted radical gastrectomy for distal gastric cancer.Methods A retrospective study was conducted on clinical data of 122 patients undergoing laparoscopic distal radical gastrectomy in our department from July 2018 to May 2019.There were 66 cases of pants-shaped anastomosis(pants-shaped group)and 56 cases of BillrothⅡtype anastomosis(BⅡgroup).The gastroscopic performance was evaluated 1 year and 2 years after operation with the residue,gastritis,bile(RGB)scale and the Los Angeles grading standard.The Gastrointestinal Quality of Life Index(GIQLI)was employed to compare the quality of life at 1 and 2 years after operation in the two groups.Results All the patients underwent the operation successfully.At 1 year after operation,the incidence of gastroscopic food residue in the pants-shaped group was significantly lower than that in the BⅡgroup(χ^(2)=13.000,P=0.000),the incidence of gastritis in the pants-shaped group was significantly lower than that in the BⅡgroup(χ^(2)=6.393,P=0.011),and the incidence of bile reflux was significantly lower than that in the BⅡgroup(χ^(2)=7.709,P=0.005).At 2 years after operation,the incidence of gastroscopic food residue in the pants-shaped group was significantly lower than that in the BⅡgroup(χ^(2)=10.095,P=0.001),the incidence of gastritis was significantly lower than that in the BⅡgroup(χ^(2)=4.058,P=0.044),and the incidence of bile reflux was significantly lower than that in the BⅡgroup(χ^(2)=12.374,P=0.000).The incidence of reflux esophagitis in the pants-shaped group was significantly lower than that in the BⅡgroup at 1 and 2 years after operation(χ^(2)=4.764,P=0.029;χ^(2)=9.872,P=0.002).The symptom,emotion,social activity and total score of the pants-shaped group were significantly higher than those of the BⅡgroup[70.0(64.5,72.0)points vs.58.0(58.0,64.3)points,Z=-4.320,P=0.000;15(14,15)points vs.14(13,14)points,Z=-2.926,P=0.003;(10.5±1.3)points vs.(9.3±1.7)points,t=3.904,P=0.000;116.5(108.3,118.8)points vs.103.0(100.0,109.3)points,Z=-4.686,P=0.000]at 1 year after operation.At 2 years after operation,the symptom,emotion and total score of the pants-shaped group were significantly higher than those of BⅡgroup[70.0(62.3,71.8)points vs.58.0(57.5,66.5)points,Z=-3.197,P=0.001;(15.5±2.5)points vs.(14.2±2.0)points,t=2.706,P=0.008;117.0(107.3,121.8)points vs.108.0(104.0,111.0)points,Z=-3.292,P=0.001].The score of social activity was significantly lower in the pants-shaped group than that in the BⅡgroup[12(11,12)points vs.14(12,14)points,Z=-4.271,P=0.000].Conclusion Pants-shaped anastomosis is safe and simple,which can effectively relieve bile reflux after distal gastric cancer radical operation,and improve the quality of life of patients,being worthy of promotion.