胃癌伴2型糖尿病患者远端胃切除术BillrothⅠ和Roux-en-Y重建的短期疗效比较

Short-term outcomes of BillrothⅠversus Roux-en-Y reconstruction after distal gastrectomy in gastric cancer patients with type 2 diabetes mellitus

背景胃癌伴2型糖尿病患者行远端胃切除术后,哪种重建方式短期疗效更好尚不明确。目的比较远端胃切除BillrothⅠ(B-I)与Roux-en-Y(R-Y)两种重建方式对胃癌伴2型糖尿病患者术后短期疗效的影响。方法回顾性分析2010年1月-2020年12月在解放军总医院第一医学中心行远端胃切除的259例胃癌伴2型糖尿病患者的临床资料,其中B-I组109例,R-Y组150例,采用倾向性评分匹配的方法平衡两组间变量,以手术时间、术后住院时间、术后早期并发症发生率等为结局指标对比两种重建方式的短期疗效。结果经倾向性评分匹配后共有170例纳入后续分析,其中B-Ⅰ组和R-Y组各85例,匹配后两组术前临床资料和病理资料的差异均无统计学意义(P>0.05)。R-Y组手术时间长于B-Ⅰ组[Md(IQR):210(184,242.5)min vs 190(164,235)min,P=0.028],术后住院时间长于B-Ⅰ组[Md(IQR):10(8,12.5)d vs9(7,11.5)d,P=0.023],Ⅱ级以上术后早期并发症发生率高于B-Ⅰ组[41.2%(35/85)vs 20.0%(17/85),P=0.003],术后胃瘫发生率高于B-Ⅰ组[15.3%(13/85)vs 4.7%(4/85),P=0.021]。两组术后第1、3、5、7天的晨起空腹血糖差异均无统计学意义(P>0.05)。结论胃癌伴2型糖尿病患者行远端胃切除术后,与R-Y重建相比,B-Ⅰ重建能够缩短手术时间、加快术后恢复,B-Ⅰ重建在降低Ⅱ级以上术后早期并发症发生率、术后胃瘫的发生率方面更有优势。

Background The reconstruction method with better short-term outcomes after distal gastrectomy in gastric cancer patients with type 2 diabetes mellitus remains unclear.Objective To compare the short-term outcomes between BillrothⅠ(B-Ⅰ)and Rouxen-Y(R-Y)reconstruction after distal gastrectomy in gastric cancer patients with type 2 diabetes mellitus.Methods Clinical data about 259 gastric cancer patients with type 2 diabetes mellitus who underwent distal gastrectomy in our hospital from January 2010to December 2020 were retrospectively analyzed.The patients were divided into B-Ⅰgroup(n=109)and R-Y group(n=150).Propensity score matching(PSM)method was used to balance the variables between the two groups.The operation time,postoperative hospital stay and the incidence of early postoperative complications of the two groups were compared.Results After PSM,a total of 170 cases were included in the subsequent analysis(85 cases in each group).There was no significant difference in preoperative clinical and pathological data between the two groups after matching(all P>0.05).The operation time(Md[IQR],210[184,242.5]min vs 190[164,235]min,P=0.028),postoperative hospital stay(Md[IQR],10[8,12.5]d vs 9[7,11.5]d,P=0.023)of the R-Y group was longer than that of the B-Ⅰgroup.The incidence of grade≥Ⅱearly postoperative complication(41.2%[35/85]vs20.0%[17/85],P=0.003),postoperative gastroparesis(15.3%[13/85]vs 4.7%[4/85],P=0.021)of the R-Y group was higher than that of the B-Ⅰgroup.There was no significant difference in fasting plasma glucose on the first,third,fifth and seventh day after operation between the two groups(all P>0.05).Conclusion Compared with the R-Y reconstruction,B-Ⅰreconstruction can shorten the operating time and accelerate postoperative recovery after distal gastrectomy in gastric cancer patients with type 2 diabetes mellitus,with the advantages of reducing the incidence of grade≥Ⅱearly postoperative complications and postoperative gastroparesis.