远端胃癌根治术行Billroth Ⅰ和改良Billroth Ⅱ消化道重建后生存质量分析
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摘要
目的:探讨胃癌患者行远端胃大部切除术后行BillrothⅠ式和改良BillrothⅡ式消化道重建的疗效。方法:回顾性分析2016年度哈尔滨医科大学附属肿瘤医院胃肠外科收治的451例胃癌患者的临床资料及随访结果,按吻合方式分为B-Ⅰ组(99例行B-Ⅰ式吻合)和B-Ⅱ组(352例行改良B-Ⅱ式吻合),比较患者的围术期、术后早期并发症及远期症状(1年以上)的情况。结果:两组患者间性别、年龄和体重指数(body mass index,BMI)比较无统计学差异。围术期:B-Ⅰ组患者的肿瘤临床分期早于B-Ⅱ组(Ⅰ期胃癌,56. 6%> 35. 2%),肿瘤直径小于B-Ⅱ组(3. 58±1. 54 <4. 88±2. 37) cm,手术时间短于B-Ⅱ组(154. 68±41. 86<171. 48±32. 69) min,术后首次排气时间长于B-Ⅱ组(116. 14±17. 70> 110. 38±18. 98) min,组间比较存在统计学差异(P <0. 05);术后正常进半流食时间无明显差异(P> 0. 05)。术后早期并发症:所有患者术后早期胃无力、吻合口出血等并发症的发生率不足5%,两组患者间分别比较均无明显统计学差异(P> 0. 05)。术后远期症状:B-Ⅱ组患者倾倒综合征等表现的发生率高于B-Ⅰ组(9. 4%> 3. 0%),消化道反流症状发生率低于B-Ⅰ组(6. 8%<17. 2%),组间比较均存在统计学差异(P <0. 05);其他如消瘦、腹胀等症状及残胃吻合口病变方面两组间比较无统计学差异(P> 0. 05)。结论:与B-Ⅰ式相比,改良B-Ⅱ式术后胆汁反流及相关并发症的发生率较低,患者生存质量较高。
Objective: To investigate the effect of BillrothⅠand modified BillrothⅡdigestive tract reconstruction after distal gastrectomy for gastric cancer patients. Methods: Clinical data and follow-up results of 451 patients,who underwent radical gastectomy for gastric cancer in gastroenterological surgery of Harbin Medical University Cancer Hospital in 2016,were analyzed retrospectively. All patients was divided into group B-Ⅰ( 99 patients with B-Ⅰanastomosis) and group B-Ⅱ( 352 patients with modified B-Ⅱanastomosis) as reconstruction modes. Perioperative condition,postoperative early complications and long-term clinical symptoms between the two groups were compared.Results: There was no statistically significant difference in gender,age and body mass index( BMI) between the two groups. In the perioperative period,the patients in group B-Ⅰwere in an earlier clinical stage of tumor( primary gastric cancer,56. 6%) than group B-Ⅱ( 35. 2%). And the patients in group B-Ⅰhad smaller tumor by diameter( 3. 58 ± 1. 54 < 4. 88 ± 2. 37) cm,shorter operation time( 154. 68 ± 41. 86 < 171. 48 ± 32. 69) min,later postoperative anal flatus by time( 116. 14 ± 17. 70 > 110. 38 ± 18. 98) min than those in group B-Ⅱ,significant difference existed between the two groups( P < 0. 05). But the first oral feeding time( 129. 62 ± 33. 30 > 123. 96 ± 52. 07) min had no significant difference( P > 0. 05). As for postoperative early complications,the incidences of gastric weakness,anastomotic bleeding,lymphatic leakage and ileus in the two groups were less than 5%,there was no significant difference between the two groups( P > 0. 05). In terms of postoperative long-term symptoms,the incidence of dumping syndrome in the two groups was 3% and 9. 4%,respectively,and the incidence of bile reflux was 17. 2% and 6. 8%,respectively. There were significant differences between the two groups( P < 0. 05). There were no significant differences in other symptoms such as emaciation,abdominal distention and gastric remnant anastomosis( P > 0. 05). Conclusion: Compared with B-Ⅰoperation,modified B-Ⅱoperation can reduce bile reflux and related complications to improve the life quality of the patients.
Objective: To investigate the effect of BillrothⅠand modified BillrothⅡdigestive tract reconstruction after distal gastrectomy for gastric cancer patients. Methods: Clinical data and follow-up results of 451 patients,who underwent radical gastectomy for gastric cancer in gastroenterological surgery of Harbin Medical University Cancer Hospital in 2016,were analyzed retrospectively. All patients was divided into group B-Ⅰ( 99 patients with B-Ⅰanastomosis) and group B-Ⅱ( 352 patients with modified B-Ⅱanastomosis) as reconstruction modes. Perioperative condition,postoperative early complications and long-term clinical symptoms between the two groups were compared.Results: There was no statistically significant difference in gender,age and body mass index( BMI) between the two groups. In the perioperative period,the patients in group B-Ⅰwere in an earlier clinical stage of tumor( primary gastric cancer,56. 6%) than group B-Ⅱ( 35. 2%). And the patients in group B-Ⅰhad smaller tumor by diameter( 3. 58 ± 1. 54 < 4. 88 ± 2. 37) cm,shorter operation time( 154. 68 ± 41. 86 < 171. 48 ± 32. 69) min,later postoperative anal flatus by time( 116. 14 ± 17. 70 > 110. 38 ± 18. 98) min than those in group B-Ⅱ,significant difference existed between the two groups( P < 0. 05). But the first oral feeding time( 129. 62 ± 33. 30 > 123. 96 ± 52. 07) min had no significant difference( P > 0. 05). As for postoperative early complications,the incidences of gastric weakness,anastomotic bleeding,lymphatic leakage and ileus in the two groups were less than 5%,there was no significant difference between the two groups( P > 0. 05). In terms of postoperative long-term symptoms,the incidence of dumping syndrome in the two groups was 3% and 9. 4%,respectively,and the incidence of bile reflux was 17. 2% and 6. 8%,respectively. There were significant differences between the two groups( P < 0. 05). There were no significant differences in other symptoms such as emaciation,abdominal distention and gastric remnant anastomosis( P > 0. 05). Conclusion: Compared with B-Ⅰoperation,modified B-Ⅱoperation can reduce bile reflux and related complications to improve the life quality of the patients.
引文
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[14]Li Q,Jia XB.Comparison of three methods of reconstruction of digestive tract after total gastrectomy for gastric cancer[J].Journal of Modern Oncology,2014,22(9):2151-2153.[李强,贾晓斌.胃癌全胃切除术后三种消化道重建方法对比研究[J].现代肿瘤医学,2014,22(9):2151-2153.]
[15]Mai C,Tang YQ,Zhao HY,et al.Comparison of long-term outcomes between Billroth-Ⅰand roux-en-y reconstruction after distal gastrectomy[J].Chinese Journal of Gastrointestinal Surgery,2014,17(5):449-452.[麦聪,唐云强,赵宏宇,等.远端胃切除术后毕Ⅰ式与Roux-en-Y消化道重建远期疗效的比较[J].中华胃肠外科杂志,2014,17(5):449-452.]
[16]Yang NZ,Fang HJ,Zhang YS,et al.Comparison of billroth-Ⅱand roux-en-Y digestive tract reconstruction after distal gastrectomy for gastric cancer[J].The Journal of Practical Medicine,2015,31(24):4110-4115.[杨年钊,方华进,张义胜,等.胃癌远端胃切除术后Roux-en-Y与BillrothⅡ消化道重建术的比较研究[J].实用医学杂志,2015,31(24):4110-4115.]
[17]Wang F,Zu HL,Jiang H,et al.Clinical investigation of combined BillrothⅡwith Braun anastomosis for patients with gastric cancer[J].Hepatogastroenterology,2014,61(134):1812-1816.
[18]Kang SH,Kim YH,Roh YH,et al.Gallstone,cholecystectomy and risk of gastric cancer[J].Annals of Hepato-Biliary-Pancreatic Surgery,2017,21(3):131.
[19]Horaguchi J,Fujita N,Kamisawa T,et al.Pancreatobiliary reflux in individuals with a normal pancreaticobiliary junction:A prospective multicenter study[J].Journal of Gastroenterology,2014,49(5):875-881.
[2]Li GX,Chen T.Digestive tract reconstruction after laparoscopic distal gastrectomy for gastric cancer[J].Chinese Journal of Operative Procedures of General Surgery(Electronic Edition),2014,8(4):12-15.[李国新,陈韬.腹腔镜胃癌远端胃切除术后消化道重建术式选择[J].中华普外科手术学杂志:电子版,2014,8(4):12-15.]
[3]Hu JK,Chen XZ.Theory and practice of digestive tract reconstruction of distal gastrectomy for gastric cancer[J].Chinese Journal of Practical Surgery,2012,32(8):613-616.[胡建昆,陈心足.胃癌远端胃切除后消化道重建理论与实践[J].中国实用外科杂志,2012,32(8):613-616.]
[4]Association JGC.Japanese gastric cancer treatment guidelines 2014(ver.4)[J].Gastric Cancer,2017,20(1):1-19.
[5]Park JY,Kim YJ.Uncut roux-en-Y reconstruction after laparoscopic distal gastrectomy can be a favorable method in terms of gastritis,bile reflux,and gastric residue[J].Journal of Gastric Cancer,2014,14(4):229-237.
[6]Qin XG,Bai RY,Yan WM,et al.Comparison of perioperative safety and middle-long term complications of roux-en-Y and billroth-Ⅰreconstructions after distal subtotal gastrectomy:A Meta-analysis[J].Chinese Journal of Bases and Clinics in General Surgery,2017,24(2):201-209.[秦晓光,白日星,闫文貌,等.胃远端大部切除术后Billroth-Ⅰ与Roux-en-Y吻合消化道重建的围手术期安全性及中远期并发症的meta分析[J].中国普外基础与临床杂志,2017,24(2):201-209.]
[7]The Surgery Branch of Chinese Medical Association.The expert consensus on the technique of digestive tract reconstruction after gastrectomy[J].Chinese Journal of Practical Surgery,2014,34(3):205-212.[中华医学会外科学分会.胃切除术后消化道重建技术专家共识[J].中国实用外科杂志,2014,34(3):205-212.]
[8]Ji JF,Ji X.Reconstruction of digestive tract after radical resection of gastric cancer:Principle and progress[J].Chinese Journal of Operative Procedures in Department of General Surgery:Electronic Version,2014,8(4):5-8.[季加孚,季鑫.胃癌根治术后消化道重建的原则与进展[J].中华普外科手术学杂志:电子版,2014,8(4):5-8.]
[9]Liang H.Options and clinical evaluation of digestive tract reconstruction after distal gastrectomy for gastric cancer[J].Chinese Journal of Digestive Surgery,2016,15(3):216-220.[梁寒.胃癌远端胃切除术后消化道重建手术方式的选择及临床评价[J].中华消化外科杂志,2016,15(3):216-220.]
[10]Kang KC,Cho GS,Han SU,et al.Comparison of billrothⅠand billrothⅡreconstructions after laparoscopy-assisted distal gastrectomy:A retrospective analysis of large-scale multicenter results from Korea[J].Surgical Endoscopy,2011,25(6):1953-1961.
[11]Liu JQ,Zhang R,Zhou W,et al.Comparison of outcomes of three reconstruction methods for radical distal gastrectomy:A matched study[J].Chinese Journal of Basics and Clinics in General Surgery,2016,23(12):1477-1482.[柳金强,张瑞,周威,等.根治性远端胃切除后3种消化道重建方式的疗效比较[J].中国普外基础与临床杂志,2016,23(12):1477-1482.]
[12]Tanaka K,Takiguchi S,Miyashiro I,et al.Impact of reconstruction method on visceral fat change after distal gastrectomy:Results from a randomized controlled trial comparing BillrothⅠreconstruction and Roux-en-Y reconstruction[J].Surgery,2014,155(3):424-431.
[13]Hu X.Reconstruction of digestive tract after distal gastrectomy[J].Chinese Journal of Gastrointestinal Surgery,2014,17(5):419-423.[胡祥.远端胃切除术后的消化道重建[J].中华胃肠外科杂志,2014,17(5):419-423.]
[14]Li Q,Jia XB.Comparison of three methods of reconstruction of digestive tract after total gastrectomy for gastric cancer[J].Journal of Modern Oncology,2014,22(9):2151-2153.[李强,贾晓斌.胃癌全胃切除术后三种消化道重建方法对比研究[J].现代肿瘤医学,2014,22(9):2151-2153.]
[15]Mai C,Tang YQ,Zhao HY,et al.Comparison of long-term outcomes between Billroth-Ⅰand roux-en-y reconstruction after distal gastrectomy[J].Chinese Journal of Gastrointestinal Surgery,2014,17(5):449-452.[麦聪,唐云强,赵宏宇,等.远端胃切除术后毕Ⅰ式与Roux-en-Y消化道重建远期疗效的比较[J].中华胃肠外科杂志,2014,17(5):449-452.]
[16]Yang NZ,Fang HJ,Zhang YS,et al.Comparison of billroth-Ⅱand roux-en-Y digestive tract reconstruction after distal gastrectomy for gastric cancer[J].The Journal of Practical Medicine,2015,31(24):4110-4115.[杨年钊,方华进,张义胜,等.胃癌远端胃切除术后Roux-en-Y与BillrothⅡ消化道重建术的比较研究[J].实用医学杂志,2015,31(24):4110-4115.]
[17]Wang F,Zu HL,Jiang H,et al.Clinical investigation of combined BillrothⅡwith Braun anastomosis for patients with gastric cancer[J].Hepatogastroenterology,2014,61(134):1812-1816.
[18]Kang SH,Kim YH,Roh YH,et al.Gallstone,cholecystectomy and risk of gastric cancer[J].Annals of Hepato-Biliary-Pancreatic Surgery,2017,21(3):131.
[19]Horaguchi J,Fujita N,Kamisawa T,et al.Pancreatobiliary reflux in individuals with a normal pancreaticobiliary junction:A prospective multicenter study[J].Journal of Gastroenterology,2014,49(5):875-881.