入口上提的改良Billroth Ⅱ+Brown吻合在腹腔镜远端胃癌根治术中的应用价值

The application value of the modified BillrothⅡ+Brown anastomosis with inlet uplift in laparoscopic radical resection of distal gastric cancer

目的:比较入口上提的改良BillrothⅡ+Brown吻合术与传统BillrothⅡ+Brown吻合术在全腔镜下远端胃癌根治性切除术中的临床应用价值。方法:回顾分析2020年1月至2022年3月收治的182例胃癌患者的临床资料,其中92例术中行入口上提的改良BillrothⅡ+Brown吻合术(观察组),90例行传统BillrothⅡ+Brown吻合术(对照组),对比分析两组患者术中情况(包括手术时间、消化道重建时间、术中出血量、淋巴结清扫数量)、术后早期肠道功能恢复情况(包括术后首次排气时间及首次下床活动时间)、并发症(包括术后十二指肠残端漏,输入袢、输出袢梗阻等)及术后半年内随访相关指标(包括胆汁反流、反流性胃炎等)。结果:两组手术时间、消化道重建时间、术中出血量、淋巴结清扫数量差异无统计学意义,观察组术后早期排气时间[(2.60±0.70)d vs.(3.10±1.20)d]、术后首次下床活动时间[(3.20±1.50)d vs.(5.10±1.30)d]早于对照组(P<0.05)。在术后并发症方面,观察组输入袢梗阻发生率(1.09%vs.7.78%)、总并发症发生率(6.52%vs.12.22%)低于对照组(P<0.05),两组在吻合口漏、输出袢梗阻等方面差异无统计学意义。在远期并发症方面,对照组胆汁反流、胃炎更严重,差异有统计学意义,两组Clavien-Dindo术后分级差异无统计学意义。结论:入口上提的改良BillrothⅡ+Brown吻合方式是安全、可行的,在术后肠道功能早期恢复、减少术后并发症、改善术后生活质量方面较传统吻合方式更具优势,具有较高的临床应用价值,值得推广。

Objective:To compare and analyze the clinical application value of modified BillrothⅡ+Brown anastomosis with inlet uplift and conventional BillrothⅡ+Brown anastomosis in totally laparoscopic radical resection of distal gastric cancer.Methods:The clinical data of 182 patients with distal gastric cancer from Jan.2020 to Mar.2022 were retrospectively analyzed.92 patients underwent intraoperative modified BillrothⅡ+Brown anastomosis with inlet uplift(observation group)and 90 patients underwent traditional BillrothⅡ+Brown anastomosis(control group).The intraoperative conditions(including surgery time,digestive tract reconstruction time,intraoperative blood loss,number of lymph node dissection),early postoperative recovery of intestinal function(including the time of postoperative first venting and time of first ambulation),complications(including postoperative duodenal stump leakage,the input loop obstruction and output loop obstruction,etc.)and postoperative follow-up relevant indexes within six-month(including bile reflux and reflux gastritis,etc.)of the two groups were comparatively analyzed.Results:The differences between the two groups were not s tatistically significant in terms of surgery time,digestive tract reconstruction time,intraoperative bleeding and the number of lymph nodes harvested.Early postoperative venting time[(2.60±0.70)d vs.(3.10±1.20)d]and time to first postoperative ambulation[(3.20±1.50)d vs.(5.10±1.30)d]in observation group were shorter than those in control group(P<0.05).In terms of postoperative complications,input loop obstruction(1.09%vs.7.78%)and total complication rate(6.52%vs.12.22%)of observation group were lower than those of control group(P<0.05),and there was no statistically significant difference between the two groups in terms of anastomotic leakage and output loop obstruction.In terms of long-term complications,the bile reflux and gastritis was more s evere in the control group than that in the observation group(P<0.05),and there was no statistically significant difference in the C lavien-Dindo postoperative grading between the two groups.Conclusions:The modified BillrothⅡ+Brown anastomosis with inlet uplift is safe and feasible,it is better than the traditional anastomosis in terms of early recovery of intestinal function,reduction of postoperative complications and improvement of postoperative quality of life.This procedure has high clinical application value and is worthy of clinical promotion.