Billroth Ⅱ与Roux-en-Y吻合对胃癌全腹腔镜远端胃切除术临床结局的影响

Influence of BillrothⅡand Roux-en-Y anastomosis on clinical outcomes of totally laparoscopic distal gastrectomy for gastric cancer

目的:探讨全腹腔镜远端胃切除术中Billroth Ⅱ与Roux-en-Y吻合对胃癌患者围手术期结局、营养状况及长期预后的影响,进一步明确两种吻合方式的可行性与安全性。方法:观察并分析2016年1月至2020年9月接受全腹腔镜远端胃切除术的125例胃癌患者的临床资料,根据消化道重建方式将患者分为Billroth Ⅱ组(n=68)与Roux-en-Y组(n=57),比较两组围手术期结局、术后并发症及营养指标。使用Kaplan-Meier曲线进行生存分析,比较两组预后结局。结果:两组术前临床资料差异无统计学意义(P>0.05)。Roux-en-Y组手术时间长于BillrothⅡ组,差异有统计学意义[(201.5±38.3)min vs.(184.1±34.2)min,P=0.028]。两组术中失血量、淋巴结获取数量、住院时间、首次排气时间、术后并发症、术后体重、营养指标及贫血指标差异均无统计学意义(P>0.05)。BillrothⅡ组与Roux-en-Y组5年无病生存率分别为69.8%与58.7%,差异无统计学意义(P=0.226)。结论:全腹腔镜远端胃切除术的消化道重建方式对胃癌患者围手术期结局、长期营养状况及生存结果无明显影响,BillrothⅡ吻合与Roux-en-Y吻合在全腹腔镜远端胃切除术中同样安全、有效。

Objective:To investigate the effects of digestive tract reconstruction(Billroth Ⅱ vs.Roux-en-Y anastomosis)on perioperative outcomes,nutritional status and long-term prognosis of gastric cancer patients who underwent totally laparoscopic distal gastrectomy(TLDG),and further determine the feasibility and safety of two reconstruction methods.Methods:This study observed and analyzed the clinical information and surgical data of 125 gastric cancer patients who underwent TLDG from Jan.2016 to Sep.2020.All patients were divided into Billroth Ⅱ group(n=68)and Roux-en-Y group(n=57)based on the different methods of digestive tract reconstruction,and perioperative outcomes,postoperative complications and nutritional indicators of two groups were compared.Kaplan-Meier curve was used for survival analysis to compare the prognostic outcomes of the 2 groups.Results:The distribution of baseline characteristics between Billroth Ⅱ group and Roux-en-Y group was comparable(P>0.05).The average operation time of Roux-en-Y group was significantly longer than that of Billroth Ⅱ group[(201.5±38.3)min vs.(184.1±34.2)min,P=0.028].There were no significant differences between the two groups in terms of intraoperative blood loss,harvested lymph node,hospital stay,time to first f latus,postoperative complications,postoperative body weight,nutritional parameters and anemia indicators(P>0.05).Kaplan-Meier curves showed that the 5 year disease-free survival rates of patients in Billroth Ⅱ group and Roux-en-Y group were 69.8%and 58.7%,respectively,there was no significant difference between the two groups(P=0.226).Conclusions:The methods of digestive tract reconstruction for TLDG do not affect the perioperative outcomes,long-term nutritional status and survival outcome of gastric cancer patients.Both Billroth Ⅱ and Roux-en-Y anastomosis are safe and effective reconstruction methods for TLDG.