[1]鲁家驹 吴泽晖 汪兵 刘刚 史良会**.胃空肠裤形吻合与BillrothⅡ(BⅡ)式吻合腹腔镜辅助远端胃癌根治术疗效的比较[J].中国微创外科杂志,2022,01(5):385-391.
　Lu Jiaju,Wu Zehui,Wang Bing,et al.Comparison of Clinical Efficacy Between Pantsshaped Gastrojejunostomy and Billroth Ⅱ Type Anastomosis After Laparoscopic Assisted Distal Gastrectomy[J].Chinese Journal of Minimally Invasive Surgery,2022,01(5):385-391.
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胃空肠裤形吻合与BillrothⅡ(BⅡ)式吻合腹腔镜辅助远端胃癌根治术疗效的比较()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
01
期数:
2022年5期
页码:
385-391
栏目:
临床研究
出版日期:
2022-07-21

文章信息/Info

Title:
Comparison of Clinical Efficacy Between Pantsshaped Gastrojejunostomy and Billroth Ⅱ Type Anastomosis After Laparoscopic Assisted Distal Gastrectomy
作者:
鲁家驹 吴泽晖 汪兵 刘刚 史良会**
(皖南医学院第一附属医院胃肠外科，芜湖241000)
Author(s):
Lu Jiaju;  Wu Zehui;  Wang Bing;  et al.
Department of Gastrointestinal Surgery, First Affiliated Hospital of Wannan Medical College, Wuhu 241000, China
关键词:
消化道重建; 裤形吻合; 远端胃切除; 胃癌
Keywords:
Digestive tract reconstruction; Pantsshaped anastomosis; Distal gastrectomy; Gastric cancer
文献标志码:
A
摘要:
目的比较胃空肠裤形吻合与BillrothⅡ(BⅡ)式吻合腹腔镜辅助远端胃癌根治术的临床疗效。方法回顾性分析2018年7月~2019年5月我科122例腹腔镜远端胃癌根治术的临床资料，其中裤形吻合66例（裤形组），BⅡ式吻合56例（BⅡ组）。采用食物残留、胃炎、胆汁反流(residue, gastritis, bile，RGB)量表与洛杉矶分级标准对术后1、2年胃镜表现进行评估，采用胃肠道生活质量指数(Gastrointestinal Quality of Life Index, GIQLI)对2组患者术后1、2年生活质量进行比较。结果所有患者均顺利完成手术。术后第1年裤形组胃镜下食物残留发生率明显低于BⅡ组(χ2=13.000，P=0000)，胃炎发生率明显低于BⅡ组 (χ2=6.393，P=0.011)，胆汁反流发生率明显低于BⅡ组 (χ2=7709,P=0.005)。术后第2年裤形组胃镜下食物残留发生率明显低于BⅡ组(χ2=10.095,P=0.001)，胃炎发生率明显低于BⅡ组 (χ2=4.058，P=0.044)，胆汁反流发生率明显低于BⅡ组 (χ2=12.374，P=0.000)。裤形组术后第1、2年反流性食管炎发生率明显低于BⅡ组(χ2=4764,P=0.029； χ2=9.872,P=0.002)。术后第1年裤形组自觉症状、心理情绪状况、社会活动、总分均明显高于BⅡ组［700(64.5,72.0)分 vs.58.0(58.0,64.3)分，Z=-4.320,P=0.000； 15(14，15)分vs.14(13,14)分,Z=-2.926,P=0003；(10.5±1.3)分vs.(9.3±1.7)分，t=3.904,P=0.000；116.5(108.3,118.8)分 vs.103.0(100.0,109.3)分,Z=-4.686,P=0.000］。术后第2年裤形组患者自觉症状、心理情绪状况、总分均明显高于BⅡ组［70.0(62.3,71.8)分vs.58.0(57.5,665)分,Z=-3.197, P=0.001；(15.5±2.5)分 vs.(14.2±2.0)分,t=2.706, P=0.008；117.0(107.3,121.8)分vs.108.0(1040,111.0)分, Z=-3.292,P=0.001］,社会活动得分明显低于BⅡ组［12(11,12)分vs.14(12,14)分,Z=-4.271,P=0.000］。结论裤形吻合能有效改善远端胃癌术后胆汁反流的问题，提高患者术后生活质量，值得推广。
Abstract:
ObjectiveTo compare the clinical efficacy of pantsshaped gastrojejunostomy and Billroth Ⅱ type anastomosis for digestive tract reconstruction after laparoscopicassisted radical gastrectomy for distal gastric cancer.MethodsA retrospective study was conducted on clinical data of 122 patients undergoing laparoscopic distal radical gastrectomy in our department from July 2018 to May 2019. There were 66 cases of pantsshaped anastomosis (pantsshaped group) and 56 cases of Billroth Ⅱ type anastomosis (BⅡ group). The gastroscopic performance was evaluated 1 year and 2 years after operation with the residue, gastritis, bile (RGB) scale and the Los Angeles grading standard. The Gastrointestinal Quality of Life Index (GIQLI) was employed to compare the quality of life at 1 and 2 years after operation in the two groups.ResultsAll the patients underwent the operation successfully. At 1 year after operation, the incidence of gastroscopic food residue in the pantsshaped group was significantly lower than that in the BⅡ group (χ2=13.000, P=0.000), the incidence of gastritis in the pantsshaped group was significantly lower than that in the BⅡ group (χ2=6393, P=0011), and the incidence of bile reflux was significantly lower than that in the BⅡ group (χ2=7.709, P=0.005). At 2 years after operation,the incidence of gastroscopic food residue in the pantsshaped group was significantly lower than that in the BⅡ group (χ2=10.095, P=0.001), the incidence of gastritis was significantly lower than that in the BⅡ group (χ2=4.058, P=0044), and the incidence of bile reflux was significantly lower than that in the BⅡ group (χ2=12.374, P=0.000). The incidence of reflux esophagitis in the pantsshaped group was significantly lower than that in the BⅡ group at 1 and 2 years after operation (χ2=4.764, P=0.029; χ2=9.872,P=0.002). The symptom, emotion, social activity and total score of the pantsshaped group were significantly higher than those of the BⅡ group ［70.0 (64.5, 72.0) points vs. 58.0 (58.0, 64.3) points, Z=-4.320,P=0000; 15 (14, 15) points vs. 14 (13, 14) points, Z=-2.926, P=0.003; (10.5±1.3) points vs. (9.3±1.7) points, t=3904, P=0000; 116.5 (108.3, 118.8) points vs. 103.0 (100.0, 109.3) points, Z=-4.686, P=0.000］ at 1 year after operation. At 2 years after operation, the symptom, emotion and total score of the pantsshaped group were significantly higher than those of BⅡ group ［70.0 (62.3, 71.8) points vs. 58.0 (57.5, 66.5) points, Z=-3.197, P=0.001; (15.5±2.5) points vs. (14.2±2.0) points, t=2.706, P=0.008; 117.0 (107.3, 121.8) points vs.108.0 (104.0, 111.0) points, Z=-3.292, P=0001］. The score of social activity was significantly lower in the pantsshaped group than that in the BⅡ group ［12 (11, 12) points vs. 14 (12, 14) points, Z=-4.271, P=0.000］.ConclusionPantsshaped anastomosis is safe and simple, which can effectively relieve bile reflux after distal gastric cancer radical operation, and improve the quality of life of patients, being worthy of promotion.

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备注/Memo

备注/Memo:
基金项目：2021年安徽省卫生健康委科研项目(AHWJ2021b109)**通讯作者, Email:shilianghui1020@163.com
更新日期/Last Update: 2022-07-21