中国实用外科杂志

中国实用外科杂志

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BillrothⅡ式与BillrothⅡ式+Brauns吻合在腹腔镜远侧胃癌根治术中应用对比研究

李    乐，李洪涛，汪亚辉，韩晓鹏，张绍艳，黄莉莉，刘宏斌   

  1. 中国人民解放军兰州总医院普外科，甘肃兰州730050
  • 出版日期:2018-09-01 发布日期:2018-09-07

  • Online:2018-09-01 Published:2018-09-07

摘要：

目的    探讨BillrothⅡ式与BillrothⅡ式+Brauns吻合方式在腹腔镜远侧胃癌根治术中的临床疗效。方法 回顾性分析中国人民解放军兰州总医院普外科2010年3月至2015年3月行腹腔镜远侧胃癌根治术的764例临床资料，其中372例消化道重建采用仅BillrothⅡ式结肠前胃空肠吻合，392例在此基础上再行Brauns吻合。观察两组病例的术中出血量、术后下床活动时间、肛门排气时间、进流食时间、术后住院时间、手术时间、住院费用及并发症。结果    所有病例均在腹腔镜下完成远侧胃癌根治术，BillrothⅡ式吻合组手术时间为（130.0±32.5）min，住院费用为（66 532.2±10 135.6）元，低于BillrothⅡ+Brauns吻合组的（140.0±36.4）min和（68 945.1±10 514.7）元；但手术后并发症碱性反流性胃炎38例（10.2%）、输入袢梗阻7例（1.9%）、倾倒综合征3例（0.8%），显著高于BillrothⅡ+Brauns吻合组的9例（2.3%）、1例（0.3%）及0例，差异均有统计学意义（P＜0.05）。两组病例在术中出血量、术后下床活动时间及术后吻合口漏、胃瘫等指标差异无统计学意义（P＞0.05）。结论    经腹腔镜远侧胃癌根治术采用BillrothⅡ式吻合和BillrothⅡ+Brauns吻合手术均安全有效，后者在碱性反流性胃炎、输入袢梗阻、倾倒综合征的发生方面明显优于前者，值得临床推广，但住院费用较高。

关键词: 吻合方式, 腹腔镜, 胃癌, 远侧胃切除术

Abstract:

Billroth Ⅱ anastomosis and Billroth Ⅱ plus Brauns anastomosis methods in laparoscopic distal gastric cancer radical operation        LI Le, LI Hong-tao, WANG Ya-hui, et al. Department of General Surgery, Lanzhou General Hospital of Lanzhou Military Region，Lanzhou 730050, China
Corresponding author：LI Le,E-mail：lzlile@163.com
Abstract    Objective    To explore Billroth Ⅱ anastomosis and Billroth Ⅱ plus Brauns anastomosis in the clinical curative effect of laparoscopic distal gastric cancer radical operation. Methods    The clinical data of 764 cases of distal gastric cancer performed laparoscopic radical operation admitted in Department of General Surgery, Lanzhou General Hospital of Lanzhou Military Region during March 2010 to March 2015 were analyzed. Among them, 372 cases were performed only Billroth Ⅱ gastric jejunum anastomosis before jejunum for reconstruction of the digestive tract，and 392 cases were performed Brauns anastomosis again on the basis of the original. The operation time，perioperative bleeding and postoperative activity time，anus exhaust time，the time when to try a liquid diet，hospital stay，operative time，hospitalization costs，complication and so on in the two groups were observed. Results    All cases were completed in distal gastric cancer radical operation by laparoscopy，comparing the Billroth Ⅱ anastomosis and Billroth Ⅱ plus Brauns anastomosis. The former operating time was（130.0±32.5）min，and the hospitalization expenses were（66 532.2±10 135.6）yuan. The latter operating time was（140.0±36.4）min and the hospitalization expenses were（68 945.1±10 514.7）yuan. In all Billroth Ⅱ anastomosis cases，the Alkaline reflux gastritis cases were 38（10.2%），the input loop obstruction in 7 cases（1.9%），the dumping syndrome in 3 cases（0.8%）. In all Billroth Ⅱ plus Brauns anastomosis    cases，the Alkaline reflux gastritis cases were 9（2.3%），the input loop obstruction in 1 case（0.3%），the dumping syndrome in 0 case. The differences were statistically significant（P＜0.05）. There were no statistically difference in perioperative bleeding and postoperative activity time，postoperative anastomotic leakage，gastric paralysis and so on in the two groups （P＞0.05）. Conclusion    In laparoscopic distal gastric cancer radical operation，both the    Billroth Ⅱ anastomosis and Billroth Ⅱ plus Brauns anastomosis are safe and effective. The latter is superior to the former in complications of Alkaline reflux gastritis，input loop obstruction，dumping syndrome，which is worth popularizing，but the hospitalization expenses are quite high.

Key words: anastomosis, laparoscope, gastric cancer, distally gastrectomy