毕Ⅱ式联合Braun吻合与单纯毕Ⅱ式吻合在全腹腔镜下远端胃癌根治术中的疗效比较
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摘要
目的探讨全腹腔镜下远端胃癌根治术中毕Ⅱ式吻合联合Braun吻合的临床疗效。方法回顾性分析笔者所在医院2012年6月至2014年6月期间收治的行全腹腔镜下远端胃癌根治术的186例远端胃癌患者的临床资料,根据术中消化道重建方式分为毕Ⅱ式+Braun吻合组86例和毕Ⅱ式吻合组100例,比较2组患者的临床疗效。结果毕Ⅱ式+Braun吻合组和毕Ⅱ式吻合组患者的手术时间、消化道重建时间、术中出血量、术后排气时间及住院时间比较差异均无统计学意义(P>0.05),而毕Ⅱ式+Braun吻合组的碱性反流性胃炎、十二指肠残端瘘、吻合口炎及术后胃瘫综合征的发生率均低于毕Ⅱ式吻合组(P<0.05)。结论在全腹腔镜下远端胃癌根治术中,毕Ⅱ式联合Braun吻合的应用减少了术后碱性反流性胃炎、十二指肠残端瘘、吻合口炎及术后胃瘫综合征的发生,是改善胃癌患者术后生存质量较理想的手术方式。
Objective To investigate the clinical efficacy and short-term complications of total laparoscopic distal gastrectomy, which adopting Billroth Ⅱ combining with Braun anastomosis. Methods Clinical data of 186 cases of distal gastric cancer who underwent total laparoscopic distal gastrectomy in our hospital from June 2012 to June 2014, including 86 cases who adopted Billroth Ⅱ combining with Braun anastomosis, and 100 cases who adopted Billroth Ⅱ anastomosis. The clinical efficacy was compared between these two groups. Results There was no significant difference in the operation time, digestive tract reconstruction time, intraoperative blood loss, postoperative exhaust time, and hospital stay(P>0.05). However, compared with Billroth Ⅱ anastomosis group, the incidence rates of alkaline reflux gastritis, duodenal fistula, anastomositis, and postsurgical gastroparesis syndrome were lower in Billroth Ⅱ combining with Braun anastomosis group(P<0.05). Conclusions The application of Billroth Ⅱ combining with Braun anastomosis in total laparoscopic distal gastrectomy could reduce the incidence rates of alkaline reflux gastritis, duodenal fistula, anastomositis, and postsurgical gastroparesis syndrome, and it is an ideal operation method to improve the quality of life for gastric cancer patients.
Objective To investigate the clinical efficacy and short-term complications of total laparoscopic distal gastrectomy, which adopting Billroth Ⅱ combining with Braun anastomosis. Methods Clinical data of 186 cases of distal gastric cancer who underwent total laparoscopic distal gastrectomy in our hospital from June 2012 to June 2014, including 86 cases who adopted Billroth Ⅱ combining with Braun anastomosis, and 100 cases who adopted Billroth Ⅱ anastomosis. The clinical efficacy was compared between these two groups. Results There was no significant difference in the operation time, digestive tract reconstruction time, intraoperative blood loss, postoperative exhaust time, and hospital stay(P>0.05). However, compared with Billroth Ⅱ anastomosis group, the incidence rates of alkaline reflux gastritis, duodenal fistula, anastomositis, and postsurgical gastroparesis syndrome were lower in Billroth Ⅱ combining with Braun anastomosis group(P<0.05). Conclusions The application of Billroth Ⅱ combining with Braun anastomosis in total laparoscopic distal gastrectomy could reduce the incidence rates of alkaline reflux gastritis, duodenal fistula, anastomositis, and postsurgical gastroparesis syndrome, and it is an ideal operation method to improve the quality of life for gastric cancer patients.
引文
1 Chen XZ,Jiang K,Hu JK,et al.Cost-ef ectiveness analysis of chemotherapy for advanced gastric cancer in China.World J Gastroenterol,2008,14(17):2715-2722.
2 Hu JK,Yang K,Zhang B,et al.D2 plus para-aortic lymphadenectomy versus standardized D2 lymphadenectomy in gastric cancer surgery.Surg Today,2009,39(3):207-213.
3 Chen XZ,Hu JK,Zhou ZG,et al.Meta-analysis of effectiveness and safety of D2 plus para-aortic lymphadenectomy for resectable gastric cancer.J Am Coll Surg,2010,210(1):100-105.
4 Japanese Gastric Cancer Association.Japanese gastric cancer treatment guidelines 2010(ver.3).Gastric Cancer,2011,14(2):113-123.
5 梁鹏,罗建管.毕Ⅱ氏胃大部分切除联合Braun吻合术46例临床分析.中国医师杂志,2008,10(2):203-205.
6 刘文韬,刘福坤.2002年版日本胃癌治疗规范.中华胃肠外科杂志,2003,6(2):131-132.
7 韩晓鹏,于建平,刘宏斌,等.应用无瘤技术行腹腔镜下胃癌D2根治术153例.解放军医药杂志,2014,26(4):60-63.
8 季加孚,季鑫.胃癌根治术后消化道重建的现状与未来.中国普外基础与临床杂志,2013,20(6):585-588.
9 黄昌明,林建贤.腹腔镜胃癌手术后消化道重建现状.中国普外基础与临床杂志,2013,20(6):593-595.
10 戚峰,刘彤,王鹏志.胃切除消化道重建方式与术后并发症.中国实用外科杂志,2013,33(4):337-339.
11 石美鑫.实用外科学.第2版.北京:人民卫生出版社,2002:763-764.
12 彭建平.Braun吻合在胃大部切除毕Ⅱ式吻合术中的应用体会.中外医学研究,2014,12(27):133-134.
13 陈孝平.外科学.第8版.北京:人民卫生出版社,2014:359-360.
14 Shen L,Shan YS,Hu HM,et al.Management of gastric cancer in Asia:resource-stratified guidelines.Lancet Oncol,2013,14(12):e535-e547.
15 惠广学,李辉,邵海涛.胃大部切除后毕Ⅱ式胃肠吻合术改良方法探讨.山东医学高等专科学校学报,2011,33(5):353-354.
16 刘铮,何纯,黄东,等.毕Ⅱ式吻合加Braun吻合术预防反流性胃炎55例分析.中外医疗,2013,32(17):22-23.
17 沈伟,张银超,陶国青,等.胃癌根治术后十二指肠残端瘘的诊治.中华普通外科杂志,2014,29(10):808-809.
18 唐云,李荣,陈凛,等.胃癌切除术后胃肠道瘘的治疗.中华普通外科杂志,2010,25(3):205-208.
19 唐云,李荣,陈凛,等.胃癌切除术后十二指肠残端瘘的营养支持.中华胃肠外科杂志,2008,11(1):47-49.
20 Uppalapati SS,Ramzan Z,Fisher RS,et al.Factors contributing to hospitalization for gastroparesis exacerbations.Dig Dis Sci,2009,54(11):2404-2409.
21 Gonzalez HC,Velanovich V.Enterra therapy:gastric neurostimulator for gastroparesis.Expert Rev Med Devices,2010,7(3):319-332.
22 Aljarallah BM.Management of diabetic gastroparesis.Saudi J Gastroenterol,2011,17(2):97-104.
23 杨维良,赵刚,张新晨.胃切除术后残胃胃瘫综合征的临床总结.中华胃肠外科杂志,2002,5(4):249-251.
24 刘凤林,秦新裕.根治性胃大部切除术后胃瘫综合征的回顾性研究.中华胃肠外科杂志,2002,5(4):245-248.
25 尤龙,张波,白鹏.Braun’s吻合预防毕Ⅱ式胃大部切除术后胃瘫的作用.中华实用诊断与治疗杂志,2009,23(3):302-303.
2 Hu JK,Yang K,Zhang B,et al.D2 plus para-aortic lymphadenectomy versus standardized D2 lymphadenectomy in gastric cancer surgery.Surg Today,2009,39(3):207-213.
3 Chen XZ,Hu JK,Zhou ZG,et al.Meta-analysis of effectiveness and safety of D2 plus para-aortic lymphadenectomy for resectable gastric cancer.J Am Coll Surg,2010,210(1):100-105.
4 Japanese Gastric Cancer Association.Japanese gastric cancer treatment guidelines 2010(ver.3).Gastric Cancer,2011,14(2):113-123.
5 梁鹏,罗建管.毕Ⅱ氏胃大部分切除联合Braun吻合术46例临床分析.中国医师杂志,2008,10(2):203-205.
6 刘文韬,刘福坤.2002年版日本胃癌治疗规范.中华胃肠外科杂志,2003,6(2):131-132.
7 韩晓鹏,于建平,刘宏斌,等.应用无瘤技术行腹腔镜下胃癌D2根治术153例.解放军医药杂志,2014,26(4):60-63.
8 季加孚,季鑫.胃癌根治术后消化道重建的现状与未来.中国普外基础与临床杂志,2013,20(6):585-588.
9 黄昌明,林建贤.腹腔镜胃癌手术后消化道重建现状.中国普外基础与临床杂志,2013,20(6):593-595.
10 戚峰,刘彤,王鹏志.胃切除消化道重建方式与术后并发症.中国实用外科杂志,2013,33(4):337-339.
11 石美鑫.实用外科学.第2版.北京:人民卫生出版社,2002:763-764.
12 彭建平.Braun吻合在胃大部切除毕Ⅱ式吻合术中的应用体会.中外医学研究,2014,12(27):133-134.
13 陈孝平.外科学.第8版.北京:人民卫生出版社,2014:359-360.
14 Shen L,Shan YS,Hu HM,et al.Management of gastric cancer in Asia:resource-stratified guidelines.Lancet Oncol,2013,14(12):e535-e547.
15 惠广学,李辉,邵海涛.胃大部切除后毕Ⅱ式胃肠吻合术改良方法探讨.山东医学高等专科学校学报,2011,33(5):353-354.
16 刘铮,何纯,黄东,等.毕Ⅱ式吻合加Braun吻合术预防反流性胃炎55例分析.中外医疗,2013,32(17):22-23.
17 沈伟,张银超,陶国青,等.胃癌根治术后十二指肠残端瘘的诊治.中华普通外科杂志,2014,29(10):808-809.
18 唐云,李荣,陈凛,等.胃癌切除术后胃肠道瘘的治疗.中华普通外科杂志,2010,25(3):205-208.
19 唐云,李荣,陈凛,等.胃癌切除术后十二指肠残端瘘的营养支持.中华胃肠外科杂志,2008,11(1):47-49.
20 Uppalapati SS,Ramzan Z,Fisher RS,et al.Factors contributing to hospitalization for gastroparesis exacerbations.Dig Dis Sci,2009,54(11):2404-2409.
21 Gonzalez HC,Velanovich V.Enterra therapy:gastric neurostimulator for gastroparesis.Expert Rev Med Devices,2010,7(3):319-332.
22 Aljarallah BM.Management of diabetic gastroparesis.Saudi J Gastroenterol,2011,17(2):97-104.
23 杨维良,赵刚,张新晨.胃切除术后残胃胃瘫综合征的临床总结.中华胃肠外科杂志,2002,5(4):249-251.
24 刘凤林,秦新裕.根治性胃大部切除术后胃瘫综合征的回顾性研究.中华胃肠外科杂志,2002,5(4):245-248.
25 尤龙,张波,白鹏.Braun’s吻合预防毕Ⅱ式胃大部切除术后胃瘫的作用.中华实用诊断与治疗杂志,2009,23(3):302-303.