基于倾向性评分匹配对比腹腔镜远端胃切除术改良与传统BillrothⅡ式吻合的临床效果

Comparison of the efficacy of modified BillrothⅡversus traditional BillrothⅡanastomosis in laparoscopic distal gastrectomy based on propensity score matching analysis

目的比较分析腹腔镜远端胃切除术中采取改良BillrothⅡ式吻合(即R法吻合)与传统BillrothⅡ式吻合完成消化道重建的临床效果。方法回顾性分析2020年7月至2023年3月苏北人民医院普外科收治的445例行腹腔镜远端胃切除术的胃癌病人的临床病理资料,消化道重建中采取的吻合方式分为R法吻合(R组,115例)和传统BillrothⅡ式吻合(传统组,330例)。传统组中包括单纯行BillrothⅡ式吻合(BⅡ亚组,116例)和BillrothⅡ+Braun吻合(B+B亚组,114例)。比较各组病人的手术相关指标及术后并发症发生情况。结果所有病人均顺利完成手术。R组的吻合时间少于传统组及BⅡ亚组、B+B亚组,差异有统计学意义[(31.3±4.4)min vs.(33.9±5.5)min vs.(34.6±5.1)min vs.(33.3±5.8)min,P<0.05],在术中出血量、淋巴结清扫数、术后排气时间、胃管留置时间、进流食时间及术后住院时间上差异无统计学意义(P>0.05)。在术后并发症方面,R组无吻合口狭窄发生,而传统组发生7例(7.3%),差异有统计学意义(P<0.05)。R组术后仅发生1例胃瘫(A级),而传统组发生11例(A级8例、B级3例),在发生率及严重程度方面差异均有统计学意义(χ^(2)=8.889、10.912,P=0.003、0.004)。结论在腹腔镜远端胃切除术消化道重建中采用基于BillrothⅡ式吻合方式改良的R法吻合,可有效缩短吻合时间,并可减少术后吻合口狭窄和胃瘫的发生,建议临床推广。

Objective To analyze the clinical effects of using modified BillrothⅡanastomosis(R-method anastomosis)and traditional BillrothⅡanastomosis to complete gastrointestinal reconstruction in laparoscopic distal gastrectomy for gastric cancer.Methods A retrospective analysis was conducted using propensity score matching on the clinical and pathological data from 445 patients diagnosed with gastric cancer who underwent laparoscopic distal gastrectomy at Subei People's Hospital in Jiangsu Province from July 2020 to March 2023.Patients were divided into two groups based on the gastrojejunostomy anastomosis method.Among them,115 patients underwent R-method gastrojejunostomy(R group)while 330 patients underwent the traditional method(traditional group).The traditional group was further categorized into simple BillrothⅡanastomosis(B2 subgroup with 116 patients)and BillrothⅡ+Braun anastomosis(B+B subgroup with 114 patients).Surgical-related indicators and incidence of complications were compared between these groups.Results All patients successfully received the surgery.The anastomosis time of the R group(31.3±4.4)min was shorter than that of the traditional group(33.9±5.5)min,B2 subgroup(34.6±5.1)min,and B+B subgroup(33.3±5.8)min,and the difference was statistically significant(P<0.05).There was no statistically significant difference in intraoperative bleeding,number of lymph node dissections,postoperative exhaust time,gastric tube retention time,inflow food time,and postoperative hospitalization time(P>0.05).In terms of postoperative complications,no anastomotic stenosis occurred in the R group,while 7 cases(7.3%)occurred in the traditional group,with a statistically significant difference(P<0.05).Only one case of gastric paralysis(grade A)occurred in the R group after surgery while 11 cases(grade A 8 cases,grade B 3 cases)occurred in the traditional group,with statistically significant differences in incidence(χ2=8.889,P=0.003)and severity(χ2=10.912,P=0.004).Conclusion The R-method gastrojejunostomy,when employed in laparoscopic distal gastrectomy for gastric cancer based on BillrothⅡanastomosis,effectively reduces anastomosis time and decreases the occurrence of postoperative anastomotic stenosis and gastric emptying dysfunction,worth wide clinical application in this context.