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

目的：比较远端胃切除术后毕Ⅰ式与Roux-en-Y消化道重建的远期疗效。方法回顾性分析2000年6月至2010年6月间在广州医科大学附属肿瘤医院接受根治性远端胃大部分切除151例胃癌患者的临床资料，其中行毕Ⅰ式消化道重建者87例（毕Ⅰ组），行Roux-en-Y消化道重建者64例（R-Y组），术后均获得了至少3年的随访。比较两组患者术后远期临床症状、营养状况、胆石形成及胃肠道并发症情况。结果术后3年，毕Ⅰ组和R-Y组胃食管反流征的发生率分别为11．5％（10／87）和4．7％（3／64），倾倒综合征的发生率分别为9．2％（8／87）和4．7％（3／64），差异并无统计学意义（均P＞0．05）。内镜评估结果显示，R-Y组食物残留、残胃（食管）炎及胆汁反流情况均显著优于毕Ⅰ组（均P＜0．05）。体质量和血清白蛋白、总胆固醇水平两组差异均无统计学意义（均P＞0．05）。除去行胆囊切除的病例，毕Ⅰ组和R-Y组的胆石形成率分别为13．2％（10／76）和15．8％（9／57），差异无统计学意义（P＞0．05）。两组胃肠道并发症发生率分别为8．0％（7／87）和4．7％（3／64），差异无统计学意义（P＞0．05）。结论远端胃大部分切除术后Roux-en-Y消化道重建者比毕Ⅰ式重建者胃食管反流及胆汁反流程度更轻，远期疗效更佳。

Comparison of long-term outcomes between Billroth- and Roux-en-Y reconstruction after distal ;gastrectomy

Objective To compare the long-term outcomes of Billroth-Ⅰ and Roux-en-Y reconstruction after distal gastrectomy. Methods Clinical data of 151 patients with gastric cancer undergoing distal gastrectomy in the Affiliated Oncologic Hospital of Guangzhou Medical University between June 2000 and June 2010 were analyzed retrospectively . Reconstruction was performed with Billroth-Ⅰ in 87 patients （B-Ⅰgroup） and Roux-en-Y in 64 （R-Y group）. All the patients were followed up for at least 3 years. Three years after operation, clinical symptoms, endoscopic findings, nutritional status , gallstone formation , and late gastrointestinal complications were compared between the two groups. Results Three years after operation, gastroesophageal reflux symptoms were found in 10 patients （11.5%） in B-Ⅰ group and in 3 （4.7%） in R-Y group , and dumping syndrome was diagnosed in 8 patients （9.2%） in B-Ⅰ group and in 3 （4.7%） in R-Y group, but the differences between the two groups were not statistically significant（both P〉0.05）. Endoscopic examination showed that the amount of residue in the gastric stump, remnant gastritis-reflux esophagitis, and bile reflux in R-Y group were better as compared to B-Ⅰ group（all P〈0.05）. Body weight, serum albumin level, and total cholesterol level were similar in the two groups （all P〉0.05）. The incidences of gallstone formation and late gastrointestinal complications did not differ between B-Ⅰgroup and R-Y group （13.2% vs. 15.8%, and 8.0% vs. 4.7% respectively, both P〉0.05）. Conclusion As compared with Billroth-Ⅰ, Roux-en-Y is associated with better long-term outcomes in terms of less remnant gastritis-reflux esophagitis and less bile reflux into the gastric remnant.