摘要
目的评价腹腔镜远端胃癌根治术Uncut Roux-en-Y、BillrothⅡ+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BillrothⅡ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(χ^(2)=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(χ^(2)=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(χ^(2)=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(χ^(2)=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�
Objective To compare the efficacy of laparoscopic gastric jejunum Uncut Roux-en-Y anastomosis with BillrothⅡ+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 BillrothⅡ+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(χ^(2)=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 statistical
作者
陆康鹏
汪刘华
王道荣
钱晶
LU Kangpeng;WANG Liuhua;WANG Daorong;QIAN Jing(Medical College of Yangzhou University,Yangzhou,Jiangsu 225001,China;Department of General Surgery,Nanjing Gulou Hospital Group Yizheng Hospital,Yangzhou,Jiangsu 211400,China;Department of Gastrointestinal Surgery,Northern Jiangsu People’s Hospital,Yangzhou,Jiangsu 225001,China;General Surgery Institute of Yangzhou,Yangzhou University,Yangzhou,Jiangsu 225001,China;Yangzhou Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases,Yangzhou,Jiangsu 225001,China)
出处
《手术电子杂志》
2024年第1期25-31,共7页
Electronic Journal of Medical Operations
关键词
腹腔镜
远端胃癌
消化道重建
胃空肠吻合术
laparoscopy
distal gastric cancer
digestive tract reconstruction
gastrojejunostomy
