不同消化道重建方式对腹腔镜胃癌术后反流的影响

目的分析腹腔镜胃癌术后胃肠反流的相关因素并探讨具体的诊疗措施。方法回顾分析1 835例行腹腔镜胃癌术后病人的临床资料，其中实施胃十二指肠吻合(毕Ⅰ式)386例，胃空肠吻合(毕Ⅱ式) 1 002例，胃空Roux-en-Y吻合412例，三角吻合35例。结果毕Ⅰ式术后发生Ⅰ级反流13例，Ⅱ级反流21例，Ⅲ+Ⅳ级反流5例。毕Ⅱ式术后发生Ⅰ级反流39例，Ⅱ级反流67例，Ⅲ+Ⅳ级反流71例。胃空Roux-en-Y吻合术后发生Ⅰ级反流9例，Ⅱ级反流7例，Ⅲ+Ⅳ级反流3例。三角吻合术后发生Ⅰ级反流1例，无Ⅱ、Ⅲ、Ⅳ级反流者。结论三角吻合在腹腔镜胃癌手术中具有较为明显抗反流的优势。

Effect of different reconstruction ways of digestive tract on the reflux after laparoscopic gastric cancer surgery

ObjectiveTo analyze the related factors of the gastrointestinal reflux after laparoscopic gastric cancer surgery, and explore its treatment measures.MethodsThe clinical data of 1835 patients treated with laparoscopic gastric cancer surgery were retrospectively analyzed.Three hundred and eighty-six cases were treated with gastroduodenal anastomosis(B-Ⅰ type), 1002 cases were treated with gastric jejunum anastomosis(B-Ⅱ type), 412 cases were treated with stomach empty Roux-en-Y anastomosis, and 35 cases were treated with triangle anastomosis.ResultsPostoperative stageⅠreflux in 13 cases, stage Ⅱ reflux in 12 cases, stage Ⅲ and Ⅳ reflux in 5 cases were identified in the patients treated with B-Ⅰtype anastomosis.Postoperative stageⅠreflux in 39 cases, stage Ⅱ reflux in 67 cases, stage Ⅲ and Ⅳ reflux in 71 cases were identified in the patients treated with B-Ⅱtype anastomosis.Postoperative stageⅠreflux in 9 cases, stage Ⅱ reflux in 7 cases, stage Ⅲ and Ⅳ reflux in 3 cases were identified in the patients treated with stomach empty Roux-en-Y anastomosis.Postoperative stageⅠreflux in 1 case, and no stage Ⅱ, Ⅲ and Ⅳ reflux case were identified in the patients treated with triangle anastomosis.ConclusionsLaparoscopic triangle anastomosis in gastric cancer surgery has more obvious advantages of anti-reflux.