Billroth II anastomosis combined with brown anastomosis reduce reflux gastritis in gastric cancer patients

BACKGROUND The surgeon performing a distal gastrectomy,has an arsenal of reconstruction techniques at his disposal,Billroth II among them.Braun anastomosis performed during a Billroth II procedure has shown evidence of superiority over typical Billroth II,in terms of survival,with no impact on postoperative morbidity and mortality.AIM To compare Billroth II vs Billroth II and Braun following distal gastrectomy,regarding their postoperative course.METHODS Patients who underwent distal gastrectomy during 2002-2021,were separated into two groups,depending on the surgical technique used(Billroth II:74 patients and Billroth II and Braun:28 patients).The daily output of the nasogastric tube(NGT),the postoperative day that NGT was removed and the day the patient started per os feeding were recorded.Postoperative complications were at the same time noted.Data were then statistically analyzed.RESULTS There was difference in the mean NGT removal day and the mean start feeding day.Mean total postoperative NGT output was lower in Braun group(399.17 mL vs 1102.78 mL)and it was statistically significant(P<0.0001).Mean daily postoperative NGT output was also statistically significantly lower in Braun group.According to the postoperative follow up 40 patient experienced bile reflux and alkaline gastritis from the Billroth II group,while 9 patients who underwent Christodoulidis G et al.Billroth II and Braun compared with Billroth II WJM https://www.wjgnet.com 2 March 20,2024 Volume 14 Issue 1 Billroth II and Braun anastomosis were presented with the same conditions(P<0.05).CONCLUSION There was evidence of superiority of Billroth II and Braun vs typical Billroth II in terms of bile reflux,alkaline gastritis and NGT output.

Which scope is appropriate for endoscopic retrograde cholangiopancreatography after Billroth II reconstruction:An esophagogastroduodenoscope or a colonoscope?

BACKGROUND Recently,with the advent of more advanced devices and endoscopic techniques,endoscopic retrograde cholangiopancreatography(ERCP)in Billroth II(B-II)patients has been increasingly performed.However,the procedures are difficult,and the techniques and strategies have not been defined.AIM To reveal the appropriate scope for ERCP in B-II patients.METHODS Sixty ERCP procedures were performed on B-II patients between June 2005 and May 2018 at Fukushima Medical University Hospital,and in 44 cases,this was the first ERCP procedure performed by esophagogastroduodenoscopy(EGDS)or colonoscopy(CS)after B-II gastrectomy.These cases were divided into two groups:17 cases of ERCP performed by EGDS(EGDS group)and 27 cases of ERCP performed by CS(CS group).The patient characteristics and ERCP procedures were compared between the EGDS and CS groups.RESULTS The procedural time was significantly shorter in the EGDS group than in the CS group[median(range):60(20-100)vs 90(40-128)min,P value<0.01].CS was an independent factor of a longer ERCP procedural time according to the univariate and multivariate analyses(odds ratio:3.97,95%CI:1.05-15.0,P value=0.04).CONCLUSION Compared to CS,EGDS shortened the procedural time of ERCP in B-II patients.

Common bile duct morphology is associated with recurrence of common bile duct stones in Billroth II anatomy patients

BACKGROUND Endoscopic retrograde cholangiopancreatography(ERCP)is the primary choice for removing common bile duct(CBD)stones in Billroth II anatomy patients.The recurrence of CBD stones is still a challenging problem.AIM To evaluate CBD morphology and other predictors affecting CBD stone recurrence.METHODS A retrospective case-control analysis was performed on 138 CBD stones patients with a history of Billroth II gastrectomy,who underwent therapeutic ERCP for stone extraction at our center from January 2011 to October 2020.CBD morphology and other predictors affecting CBD stone recurrence were examined by univariate analysis and multivariate logistic regression analysis.RESULTS CBD morphology(P<0.01)and CBD diameter≥1.5 cm(odds ratio[OR]=6.15,95%confidence interval[CI]:1.87-20.24,P<0.01)were the two independent risk factors.In multivariate analysis,the recurrence rate of patients with S type was 16.79 times that of patients with straight type(OR=16.79,95%CI:4.26-66.09,P<0.01),the recurrence rate of patients with polyline type was 4.97 times that of patients with straight type(OR=4.97,95%CI:1.42-17.38,P=0.01),and the recurrence rate of S type patients was 3.38 times that of patients with polyline type(OR=3.38,95%CI:1.07-10.72,P=0.04).CONCLUSION CBD morphology,especially S type and polyline type,is associated with increased recurrence of CBD stones in Billroth II anatomy patients.

Randomized controlled trial of uncut Roux-en-Y vs Billroth Ⅱ reconstruction after distal gastrectomy for gastric cancer: Which technique is better for avoiding biliary reflux and gastritis?

AIM To identify which technique is better for avoiding biliary reflux and gastritis between uncut Roux-en-Y and Billroth Ⅱ reconstruction. METHODS A total of 158 patients who underwent laparoscopyassisted distal gastrectomy for gastric cancer at the First Hospital of Jilin University(Changchun, China) between February 2015 and February 2016 were randomized into two groups: uncut Roux-en-Y(group U) and Billroth II group(group B). Postoperative complications and relevant clinical data were compared between the two groups. RESULTS According to the randomization table, each group included 79 patients. There was no significant difference in postoperative complications between groups U and B(7.6% vs 10.1%, P = 0.576). During the postoperative period, group U stomach p H values were lower than 7 and group B p H values were higher than 7. After 1 year of follow-up, group B presented a higher incidence of biliary reflux and alkaline gastritis. However, histopathology did not show a significant difference in gastritis diagnosis(P = 0.278), and the amount of residual food and gain of weight between the groups were also not significantly different. At 3 mo there was no evidence of partial recanalization of uncut staple line, but at 1 year the incidence was 13%. CONCLUSION Compared with Billroth II reconstruction, uncut Rouxen-Y reconstruction is secure and feasible, and can effectively reduce the incidence of alkaline reflux, residual gastritis, and heartburn. Despite the incidence of recanalization, uncut Roux-en-Y should be widely applied.

Laparoscopy-assisted D2 radical distal gastrectomy for gastric cancer (Billroth Ⅱ anastomosis)

Laparoscopic radical gastrectomy has been increasingly applied in China. However, how to reduce surgery-related trauma, shorten operative time and achieve the long-term prognosis equal to the conventional open surgery is still hot research topics. Along with the change in learning curve and the optimization of endoscopic techniques, laparoscopic lymph node dissection can achieve or even exceed the extent that can be achieved in open surgery. Therefore, it has gradually replaced the conventional digestive tract reconstruction using an auxiliary incision. By completing the laparoscopic digestive tract reconstruction with EndoGIA, we describe the laparoscopy-assisted D2 radical distal gastrectomy for gastric cancer （Billroth Ⅱ anastomosis）.

BillrothⅠ式与BillrothⅡ式吻合术在远端胃癌手术中的比较

目的探讨远端胃癌手术的消化道重建方式。方法对我院1999年9月～2004年9月收治并手术治疗的115例远端胃癌进行回顾性分析。行BillrothⅡ式手术56例,BillrothⅠ式手术59例。比较术后并发症、住院时间、治疗费用、5年生存率。结果 BillrothⅡ式并发症发生率、术后住院时间、住院费用都远高于BillrothⅠ式(P<0.05)。两者的5年生存率相似(P>0.05)。结论 BillrothⅠ式吻合术重建消化道,操作简单,符合生理,减少术后并发症,提高患者术后的生存质量,是根治性远端胃切除术后理想的消化道重建方式。

ERCP for patients who have undergone Billroth Ⅱ gastroenterostomy and Braun anastomosis

Endoscopic retrograde cholangiopancreatography(ERCP)is efficacious in patients who have undergone Billroth Ⅱ gastroenterostomies,but the success rate decreases in patients who also have experienced Braun anastomoses.There are currently no reports describing the preferred enterography route for cannulation in these patients.We first review the patient’s previous surgery records,which most often indicate that the efferent loop is at the greater curvature of the stomach.We recommend extending the duodenoscope along the greater curvature of the stomach and then advancing it through the"lower entrance"at the site of the gastrojejunal anastomosis,along the efferent loop,and through the"middle entrance"at the site of the Braun anastomosis to reach the papilla of Vater.Ten patients who had each undergone BillrothⅡgastroenterostomy and Braun anastomosis between January 2009 and December 2011 were included in our study.The overall success rate of enterography was 90% for the patients who had undergone BillrothⅡgastroenterostomy and Braun anastomosis,and the therapeutic success rate was 80%.We believe that this enterography route for ERCP is optimal for a patient who has had BillrothⅡgastroenterostomy and Braun anastomosis and helps to increase the success rate of the procedure.

不同吻合方式在腹腔镜远端胃癌根治术中的疗效和安全性

目的:探讨非离断Roux-en-Y吻合与毕II+Braun吻合在腹腔镜远端胃癌根治术中的疗效和安全性。方法:回顾性分析2019年3月至2022年2月六安市中医院胃肠外科收治并行腹腔镜远端胃癌根治术患者的临床资料。根据术中消化道重建方式分为2组(行毕II+Braun吻合术者作为毕II+Braun组,行非离断Roux-en-Y吻合术者作为Uncut RY组),2组各55例,比较2组疗效及营养状况及术后6个月胃食管反流病问卷(Gastroesophageal Reflux Disease Questionnaire,GerdQ)得分。结果:2组手术时间、术中出血量、切开长度、消化道重建时间及淋巴结清扫数比较,差异均无统计学意义(均P>0.05)。Uncut RY组首次排气时间及恢复进食时间均短于毕II+Braun组(均P<0.05)。术后6个月,2组体重、血红蛋白及白蛋白水平均升高(均P<0.05),且Uncut RY组较毕II+Braun组更高(均P<0.05);Uncut RY组GerdQ总分及各维度评分均低于毕II+Braun组(均P<0.05);Uncut RY组远期并发症总发生率低于毕II+Braun组(P<0.05)。结论:与毕II+Braun吻合相比,非离断Roux-en-Y吻合能明显促进患者术后恢复,并减少远期并发症发生。

胃大部分切除术后ROUX-en-Y吻合及毕Ⅱ式吻合对2型糖尿病血糖的影响

目的:研究胃大部分切除手术后进行ROUX-en-Y吻合与毕II式吻合重建对2型糖尿病患者血糖的影响。方法前瞻、非随机对我科2006年1月至2009年12月收治的40例不合并肥胖的胃癌及胃溃疡患者接受ROUX-en-Y吻合重建26例与毕II式吻合重建24例。检测手术前后血糖及糖化血红蛋白(HbA1c)的变化。结果 ROUX-en-Y吻合重建组:空腹血糖在术后1月下降(P<0.05),餐后2h血糖在术后第1周下降(P<0.05),糖化血红蛋白在术后1月下降(P<0.05);毕II式吻合重建组:空腹血糖在术后6月下降(P<0.05),餐后2 h血糖在术后第1月下降(P<0.05),糖化血红蛋白在术后3月下降(P<0.05)。两组相比:术后1月空腹血糖及6月餐后2 h血糖差异有统计学意义(P<0.05),术后3月糖化血红蛋白差异有统计学意义(P<0.05)。结论胃大部分切除手术后进行ROUX-en-Y吻合重建与毕II式吻合重建均能够降低2型糖尿病患者的血糖,但以ROUX-en-Y吻合重建手术效果较为显著。ROUX-en-Y吻合重建术后血糖的下降可能与血中胰高血糖素样肽-1水平升高有关。

经皮肝穿刺球囊扩张十二指肠乳头括约肌取石术治疗胆总管结石3例

目的探讨经皮肝穿刺球囊扩张十二指肠乳头括约肌取石术治疗胆总管结石的临床价值。方法对3例胃切除毕Ⅱ式手术和胆总管切开取石术后复发,经十二指肠镜取石失败的患者行经皮肝穿刺扩张胆管,用球囊扩张十二指肠乳头括约肌后将结石推入十二指肠的取石术治疗胆总管结石。结果 3例患者均一次性手术成功,术后放置内外引流管,1周内再次造影未见胆管残余结石影。结论经皮肝穿刺球囊扩张十二指肠乳头括约肌取石术治疗胆总管结石安全可行,对不宜手术且内镜取石失败的胆管结石治疗有重要价值。

腹腔镜辅助毕Ⅱ式与Roux-en-Y消化道重建的临床疗效分析

目的：探究腹腔镜辅助毕Ⅱ式对比Roux-en-Y远端胃癌根治术后消化道重建临床疗效。方法 ：纳入2014年1月—2015年6月确诊为远端胃癌的186例患者,随机分为RY组、毕Ⅱ组各93例。对两组患者临床指标、并发症进行比较,并绘制生存曲线图比较两种术式消化道重建后患者的总生存期。结果：腹腔镜辅助下毕II式消化道重建术在手术时间（t=4.711,P=0.001）、术中出血量（t=8.18,P〈0.001）方面优于RY组,但在淋巴结清除数目（t=0.428,P=0.674）,术后排气时间（t=1.874,P=0.079）,住院时间（t=1.538,P=0.144）及免疫学指标方面两者差异无统计学意义（P〉0.05）。通过对术后并发症的分析发现,毕Ⅱ式较Roux-en-Y式可明显降低患者的肺部感染率（χ~2=2.581,P=0.01）,但术后切口感染（χ~2=0.58,P=0.56）方面两者差异无统计学意义。术后随访1年,在肠梗阻（χ~2=1.55,P=0.12）、吻合口瘘（χ~2=1.356,P=0.175）及胃无力（χ~2=0.384,P=0.701）等的发生率方面,两组患者差异无统计学意义（P〉0.05）。绘制生存曲线图进行比较,两组患者的总生存期差异无统计学意义（χ~2=0.320,P=0.572）。结论：腹腔镜辅助下毕Ⅱ式消化道重建术与Roux-en-Y相比,具有手术时间短、术中出血量少、术后肺部感染率低等优点,但不能明显降低患者远期并发症、改善患者的免疫功能及总生存期。还需进一步多中心、大样本的随机对照试验验证。

残胃癌易发因素和特点的研究

目的分析良恶性疾病行胃大部切除手术后,发生残胃癌的临床相关因素.方法回顾该科1993～2003年间治疗的残胃癌29例,根据临床病理因素找出残胃癌发生的特点和相关因素.结果在发生残胃癌的诸多可能的原因中,首次手术的方式与残胃癌的发生具有相关性,即毕Ⅱ式吻合方式发生残胃癌的机率大,残胃癌多发生在残胃吻合口处(P＜0.05);良性疾病手术后发生残胃癌的平均时间较恶性病变手术后发生残胃癌的时间较长(P＜0.05).结论良性胃、十二指肠疾病手术后发生残胃癌的间隔时间长;残胃癌好发于毕Ⅱ式吻合方式并且多发于吻合口.

毕Ⅰ式与毕Ⅱ式吻合术应用于根治性远端胃切除术的疗效分析

目的通过比较分析胃癌行胃大部切除术后行毕Ⅰ式和毕Ⅱ式重建术后观察并发症的发生情况,探讨其原因及防治原则。方法选择本院2007年4月-2009年7月检出的200例胃癌患者按毕Ⅰ式和毕Ⅱ式胃大切术后分组,并统计并发症的发生情况进而进行回顾性分析。结果残胃病变的发生率在胃大部切除术后行毕Ⅰ式和毕Ⅱ式后高达93.5%,其中胆汁反流在毕I式术后的发生率为17.9%,明显低于毕Ⅱ式术后的发生率69.2%,毕I式术后残胃原发癌、残胃及吻合口炎的发生率分别为5.9%、44.8%,均显著低于毕Ⅱ式术后的36.1%和77.4%的发生率;残胃及吻合口溃疡在毕I式术后的发生率为23.9%,明显高于毕Ⅱ式术后的59.4%(P<0.01);在两组中其余残胃病变的比较差异无统计学意义(P>O.05)。结论胃大部切除术是治疗胃恶性肿瘤的主要方法,毕I式术后发生并发症的概率要远低于毕Ⅱ式;防治残胃病变尤其是残胃癌,复查内镜及病理是重要措施。

消化性溃疡患者行胃大部切除术后残胃癌危险因素分析

目的分析消化性溃疡患者接受胃大部切除术后残胃癌发生的危险因素。方法胃大部切除术后残胃癌和未患残胃癌的患者各60例，比较两组的常见临床特征。结果残胃癌以术后10—20年内最为高发。相比较对照组，发生残胃癌的患者以十二指肠溃疡为原发病，首次手术时接受毕Ⅱ式吻合术的比例较高（P〈0．05）。结论消化性溃疡接受胃大部切除的患者在术后10年后应继续随访，对于有胃十二指肠返流的患者的随访应予以加强。

Health-related quality of life after curative resection for gastric adenocarcinoma

BACKGROUND With improved survival in gastric cancer patients,health-related quality of life has become an important clinical endpoint alongside primary oncological outcomes.AIM To investigate health-related quality of life after various surgical procedures for gastric cancer treatment.METHODS The validated Slovenian version of the European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire(QLQ-C30)and its gastric cancer-specific module(QLQ STO-22)was sent for self-completion to patients that underwent curative resection for gastric adenocarcinoma between January 2014 and December 2018 at our centre.In total,116 patients responded.Scores were compared between patients after subtotal distal vs total gastrectomy and patients after subtotal distal gastrectomy with Billroth II vs Roux-en-Y reconstruction.RESULTS Interestingly,the extent of resection did not influence daily functioning;however,more dysphagia and eating restrictions were reported in patients after total gastrectomy when compared to patients after subtotal distal gastrectomy.Moreover,patients with Billroth II reconstruction after subtotal distal resection experienced worse physical and role functioning and reported more pain,fatigue and reflux compared to Roux-en-Y reconstruction.CONCLUSION Based on our results,Roux-en-Y reconstruction after subtotal distal gastrectomy should be preferred over Billroth II reconstruction.The data obtained from this study will help surgeons when preoperatively informing their patients about expected functional outcomes after gastrectomy and enable them to ensure proper supportive care of their patients in the postoperative period.

Mixed neuroendocrine carcinoma of the gastric stump: A case report

BACKGROUND Gastric stump cancer,also known as gastric remnant cancer(GRC),is one of the main complications of postgastrectomy syndrome,which usually occurs following Billroth II reconstruction.The predominant histological subtype of GRC is adenocarcinoma,whereas neuroendocrine carcinoma is relatively rare.In particular,there are few recently reported cases of mixed neuroendocrine carcinoma(MNEC)in the English literature.Here,we present an extremely rare case of MNEC of the gastric stump.CASE SUMMARY A 59-year-old patient presented to our department owing to chronic constipation.He had undergone subtotal gastric resection 35 years prior to admission because of benign peptic ulcer.After admission,the patient underwent several tests,and gastroendoscopy showed evidence of Billroth II gastrectomy and local thickening of the gastric stump mucosa at the gastrojejunostomy site,with bile reflux;pathological biopsy revealed adenocarcinoma.He was then diagnosed with GRC and underwent total gastrectomy,D2 Lymphadenectomy,and esophagojejunal Roux-en-Y reconstruction.Histopathological examination of the specimen identified MNEC comprising MNEC(60%),adenocarcinoma(30%),and squamous cell carcinoma(10%).Postoperative adjuvant chemotherapy was initiated on September 17,2020.Taxol plus cisplatin was administered for only one cycle because of severe liver function damage,and the regimen was changed to etoposide plus cisplatin on October 10,2020 for five cycles.The patient recovered,with no recurrence after 6 mo of follow-up.CONCLUSION Gastric MNECs(GMNECs)is a rare type of GRC.This study presented the unusual occurrence of GMNEC in the gastric stump.This case will contribute to improvements in our understanding of the carcinogenesis,biology,pathology,and behavior of GMNEC and GRC.

手术治疗胃溃疡的临床治疗分析

目的：对手术治疗胃溃疡的临床疗效进行探讨.方法：对我院2007年6月～2010年6月收治的60例胃溃疡患者的资料以及采用三种不同手术方法进行治疗的临床效果进行回顾性分析.结果：在治疗总有效率方面,BillrothⅠ式胃空肠吻合术最高（100%）,Roux-en-Y胃空肠吻合术较高（93.3%）,BillrothⅡ式胃空肠吻合术相对较低,三组患者治疗总有效率比较差异无统计学意义,P〉0.05,在术后伤口感染、输入袢梗阻以及吻合口溃疡的并发症方面,BillrothⅡ式胃空肠吻合术的发病率最高,为63.3%,且并发倾倒综合征,其次为Roux-en-Y胃空肠吻合术的26.6%,BillrothⅠ式胃空肠吻合术在本组患者中发病率最低,为10.0%.三组患者之间的术后生活质量评分差异不具有统计学意义（P〉0.05）,但相比于治疗前均有显著提高（P〈0.05）.结论：通过本次临床疗效分析显示,BillrothⅠ式胃空肠吻合术并发症较少,临床疗效较好,值得临床推广.

Current status of endoscopic retrograde cholangiopancreatography in patients with surgically altered anatomy

Endoscopic retrograde cholangiopancreatography(ERCP)in patients with surgically altered anatomy must be performed by a highly experienced endoscopist.The challenges are accessing the afferent limb in different types of reconstruction,cannulating a papilla with a reverse orientation,and performing therapeutic interventions with uncommon endoscopic accessories.The development of endoscopic techniques has led to higher success rates in this group of patients.Device-assisted ERCP is the endoscopic procedure of choice for high success rates in short-limb reconstruction;however,these success rate is lower in long-limb reconstruction.ERCP assisted by endoscopic ultrasonography is now popular because it can be performed independent of the limb length;however,it must be performed by a highly experienced and skilled endoscopist.Stent deployment and small stone removal can be performed immediately after ERCP assisted by endoscopic ultrasonography,but the second session is needed for other difficult procedures such as cholangioscopy-guided electrohydraulic lithotripsy.Laparoscopic-assisted ERCP has an almost 100%success rate in longlimb reconstruction because of the use of a conventional side-view duodenoscope,which is compatible with standard accessories.This requires cooperation between the surgeon and endoscopist and is suitable in urgent situations requiring concomitant cholecystectomy.This review focuses on the advantages,disadvantages,and outcomes of various procedures that are suitable in different situations and reconstruction types.Emerging new techniques and their outcomes are also discussed.

Short-type single balloon enteroscope for endoscopic retrograde cholangiopancreatography with altered gastrointestinal anatomy

AIM:To evaluate the effectiveness of a short-type single-balloon-enteroscope(SBE) for endoscopic retrograde cholangiopancreatography(ERCP) in patients with a reconstructed intestine.METHODS:Short-type SBE was developed to perform ERCP in postoperative patients with a reconstructed intestine.Short-type SBE is a direct-viewing endoscope with the following specifications:working length,1520 mm;total length,1840 mm;channel diameter,3.2 mm.In addition,short-type SBE has a water-jet channel.The study group comprised 22 patients who underwent 31 sessions of short-type SBE-assisted ERCP from June 2011 through May 2012.Reconstruction was performed by Billroth-Ⅱ(B-Ⅱ) gastrectomy in 6 patients(8 sessions),Roux-en-Y(R-Y) gastrectomy in 14 patients(21 sessions),and R-Y hepaticojejunostomy in 2 patients(2 sessions).We retrospectively studied the rate of reaching the blind end(papilla of Vater or choledochojejunal anastomosis),mean time required to reach the blind end,diagnostic success rate(defined as the rate of successfully imaging the bile and pancreatic ducts),therapeutic success rate(defined as the rate of successfully completing endoscopic treatment),mean procedure time,and complications.RESULTS:Among the 31 sessions of ERCP,the rate of reaching the blind end was 88% in B-Ⅱ gastrectomy,91% in R-Y gastrectomy,and 100% in R-Y hepaticojejunostomy.The mean time required to reach the papilla was 18.3 min in B-Ⅱ gastrectomy,21.1 min in R-Y gastrectomy,and 32.5 min in R-Y hepaticojejunostomy.The diagnostic success rates in all patients and those with an intact papilla were respectively 86% and 86% in B-Ⅱ gastrectomy,90% and 87% in R-Y gastrectomy,and 100% in R-Y hepaticojejunostomy.The therapeutic success rates in all patients and those with an intact papilla were respectively 100% and 100% in B-Ⅱ gastrectomy,94% and 92% in R-Y gastrectomy,and 100% in R-Y hepaticojejunostomy.Because the channel diameter was 3.2 mm,stone extraction could be performed with a wire-guided basket in 12 sessions,and wireguided intraductal ultrasonography could be performed in 8 sessions.As for complications,hyperamylasemia(defined as a rise in serum amylase levels to more than 3 times the upper limit of normal) occurred in 1 patient(7 sessions) with a B-Ⅱ gastrectomy and 4 patients(19 sessions) with an R-Y gastrectomy.After ERCP in patients with an R-Y gastrectomy,2 patients(19 sessions) had pancreatitis,1 patient(21 sessions) had gastrointestinal perforation,and 1 patient(19 sessions) had papillary bleeding.Pancreatitis and bleeding were both mild.Gastrointestinal perforation improved after conservative treatment.CONCLUSION:Short-type SBE is effective for ERCP in patients with a reconstructed intestine and allows most conventional ERCP devices to be used.

毕Ⅱ式吻合术联合改良Braun吻合术对腹腔镜远端胃癌切除术患者的临床疗效及安全性

目的探讨毕Ⅱ式吻合术联合改良Braun吻合术对腹腔镜远端胃癌切除术患者的临床疗效及安全性。方法回顾性分析124例接受腹腔镜远端胃癌切除术的远端胃癌患者的临床资料,根据消化道重建方式不同,分为联合组(n=68)和毕Ⅱ式组(n=56)。联合组患者接受毕Ⅱ式吻合术联合改良Braun吻合术,毕Ⅱ式组患者接受单纯毕Ⅱ式吻合术,比较两组患者围手术期相关指标、术后并发症发生率和Visick分级情况等。结果联合组与毕Ⅱ式组患者的手术时间、消化道重建时间、术中出血量、术后排气时间和住院时间比较,差异均无统计学意义(P﹥0.05)。联合组患者术后早期腹泻、反流、术后胃瘫综合征和梗阻的发生率均低于毕Ⅱ式组患者(P﹤0.05);但两组患者的吻合口瘘发生率比较,差异无统计学意义(P﹥0.05)。术后6个月,联合组患者Visick分级情况优于毕Ⅱ式组患者,差异有统计学意义(P﹤0.05)。结论毕Ⅱ式吻合术联合改良Braun吻合术可有效改善腹腔镜远端胃癌切除术患者的临床疗效,降低术后早期并发症发生率,提高患者的生活质量。