摘要
目的 评价腹腔镜远端胃癌根治术Uncut Roux-en-Y、Billroth Ⅱ+Braun这两类消化道重建途径的临床效果.方法 回顾性分析江苏省苏北人民医院胃肠中心 2020 年 1 月—2022 年 4 月治疗的 102名腹腔镜远端胃癌根治术(LDG)病人的临床资料.其中 42 人采用Uncut Roux-en-Y吻合术,被归入URY组,60 人采用Billroth Ⅱ联合Braun吻合术,被归入B2B组.对比两组研究对象的基本信息、围手术期相关参数、术后近期并发症与营养情况,以及术后 12 个月胃镜检查结果,同时采用QLQ-STO 22 量表对其术后生活质量展开评估.结果 两组皆顺利完成LDG手术,无 1 例中转开腹与围术期死亡情况.两组在手术用时、吻合时间、术中出血量、术后首次排气时间、进食流质时间、拔除引流管时间、术后住院天数上,差异无统计学意义(P>0.05).两组在术后近期并发症(含吻合口瘘、十二指肠残端瘘、切口感染、肠梗阻等)发生率上,差异无统计学意义(P>0.05).随访 1 年,URY组 1 例患者出现肝转移;B2 B组 2 例出现肿瘤复发,其中 1 例为肝转移,另 1 例并发腹腔广泛转移死亡.术后 1 年 91 例完成胃镜检查,其中URY组 37 例,B2 B组 54 例.URY组出现胃潴留 5 例(13.5%),B2 B组 18 例(33.3%),差异有统计学意义(χ2 =4.567,P=0.033);发生胆汁反流分别有 3 例(8.1%)、16 例(29.6%),差异有统计学意义(χ2 =6.156,P=0.013);发生反流性胃炎分别为 1 例(2.7%)、12 例(22.2%),差异有统计学意义(χ2 =6.832,P=0.009);发生反流性食管炎分别为 1 例(2.7%)、3 例(5.6%),差异无统计学意义(χ2 =0.017,P=0.895).术后 1 年评估病人营养情况,两组血淋巴细胞计数(LC)、血红蛋白(Hb)、总蛋白(TP)、血清白蛋白(Alb)、预后营养指数(PNI)等指标比较,无明显统计学差异(P>0.05).术后 1 年 64 例完成胃癌(GC)病人生活质量调查问卷(QLQ-STO 22),URY组 28 例,B2B组 36 例.结果显示与B2B组比较,URY组减少了反流,差异有统计学意义(P<0.05).结论 Uncut Roux-en-Y吻合术减少了胃潴留、胆汁反流和反流性胃炎的发生,改善了患者的生活质量.Uncut Roux-en-Y吻合术途径在LDG消化道重建方面为理想之选.
Abstract
Objective To compare the efficacy of laparoscopic gastric jejunum Uncut Roux-en-Y anastomosis with Billroth Ⅱ +Braun anastomosis in the surgical treatment of distal gastric cancer.Methods The data of 102 patients undergoing laparoscopic radical gastrectomy for distal gastric cancer from January 2020 to April 2022 in the Gastrointestinal Center of Northern Jiangsu People's Hospital were retrospectively analyzed.Of them,42 patients underwent Uncut Roux-en-Y anastomosis and were assigned to the URY group,and 60 patients underwent Billroth Ⅱ +Braun anastomosis and were assigned to the B 2 B group.The general data,perioperative indicators,postoperative complications,nutritional status,and gastroscopy 1 year after surgery were compared between the two groups.And the quality of life of the two groups was evaluated using QLQ-STO22 scale at 1 year after surgery.Results Laparoscopic radical GC resection was successfully performed in both groups,without conversion to laparotomy and perioperative death.There were no significant differences in operation time,anastomosis time,intraoperative blood loss,first postoperative exhaust time,liquid feeding time,drainage tube removal time and postoperative hospitalization time between the two groups(P>0.05).There were no significant differences in postoperative anastomotic fistula,duodenal stump fistula,intestinal obstruction and incision infection between the two groups(P>0.05).During 1-year follow-up,1 patient in the URY group developed liver metastasis,and 2 patients in the B2 B group had tumor recurrence,of whom 1 patient had liver metastasis and 1 patient with extensive abdominal metastasis died.One year after surgery,91 cases completed gastroscopy,including 37 cases in URY group and 54 cases in B2 B group.There were 5 cases(13.5％)of gastric retention in URY group and 18 cases(33.3％)in B2 B group,the difference was statistically significant(χ2 =4.567,P =0.033).For bile reflux,there were 3 cases(8.1％)and 16 cases(29.6％)in two groups,respectively,and the difference was statistically significant(χ2 =6.156,P =0.013).There were 1 case(2.7％)and 12 cases(22.2％)of reflux gastritis in two groups,respectively,and the difference was statistically significant(χ2 =6.832,P =0.009).There was no significant difference in reflux esophagitis between the two groups with 1 case(2.7％)and 3 cases(5.6％),respectively(χ2 =0.017,P =0.895).The nutritional status of the two groups was assessed 1 year after surgery,and no significant differences in hemoglobin,serum albumin,total protein,blood lymphocyte count and PNI between the two groups(P>0.05)were observed.One year after surgery,64 cases completed QLQ-STO22 questionnaire survey,with 28 cases in URY group and 36 cases in B2 B group.The score showed that compared with B 2 B group,reflux score was reduced in URY group,and the difference was statistically significant(P<0.05).Conclusion Uncut Roux-en-Y anastomosis procedure is an ideal reconstruction of the digestive tract in patients with gastric cancer after laparoscopic radical distal gastrectomy,reducing gastric retention,bile reflux and reflux gastritis,and improving the quality of life of patients after surgery.
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