【摘要】：背景:有數(shù)據(jù)表明,我國胃癌病人的發(fā)病率高居全世界第二位。每年約679100人新診斷為胃癌,498000人死于胃癌。其中,遠(yuǎn)端胃癌約占50%。迄今為止臨床上能夠治愈胃癌的唯一手段只有以外科手術(shù)為主導(dǎo)的綜合診療。胃癌根治術(shù)后進(jìn)行消化道重建的方法經(jīng)多年發(fā)展改良后多種多樣,其中在我國遠(yuǎn)端胃癌根治術(shù)后最常用的吻合法主要有三種,分別為Billroth Ⅰ式、Billroth Ⅱ式以及Roux-en-Y吻合,三種吻合術(shù)式各有利弊,目前還沒有臨床上公認(rèn)的最佳選擇。本文就三種胃癌術(shù)后消化道重建方式進(jìn)行臨床數(shù)據(jù)資料的對比分析,以期能夠?yàn)檫h(yuǎn)端胃癌根治術(shù)后消化道重建方式的合理選擇提供臨床依據(jù)。目的:通過對收集的相關(guān)數(shù)據(jù)進(jìn)行臨床對比分析,對遠(yuǎn)端胃癌根治術(shù)后三種常見消化道重建方式的合理性作再探討。方法:通過回顧性選取從2014年9月到2016年3月期間于吉林大學(xué)中日聯(lián)醫(yī)院胃腸外科行遠(yuǎn)端胃癌根治術(shù)后消化道重建的病人。入組病人既往無腹部手術(shù)史,術(shù)前有本院明確的胃鏡病理報(bào)告證實(shí)為胃癌,病灶位于胃下部或部分胃小彎側(cè)。結(jié)合術(shù)前CT、超聲等輔助檢查無遠(yuǎn)處轉(zhuǎn)移,術(shù)前調(diào)整身體狀態(tài)可耐受手術(shù),限期擬行遠(yuǎn)端胃癌根治術(shù),術(shù)后病理與術(shù)前病理一致。入組病人共87例,其中Billroth Ⅰ式22例、Billroth Ⅱ式32例,Roux-en-Y吻合33例。對病人一般資料及圍術(shù)期指標(biāo)如手術(shù)時(shí)間(min)、術(shù)中出血量(ml)、胃腸功能恢復(fù)時(shí)間(d)、術(shù)后住院時(shí)間(d)、術(shù)后消化道功能恢復(fù)情況,病人術(shù)后6月特殊癥狀量表隨訪調(diào)查、術(shù)后1年內(nèi)并發(fā)癥情況等指標(biāo)進(jìn)行統(tǒng)計(jì)學(xué)分析。結(jié)果:1.三組病人在年齡、性別、病理類別及TNM分期等一般臨床數(shù)據(jù)上未發(fā)現(xiàn)明顯差異((P0.05),沒有統(tǒng)計(jì)學(xué)意義,具有可比性。2.三組病人手術(shù)時(shí)間和術(shù)中出血量與手術(shù)操作的復(fù)雜程度表現(xiàn)為正相關(guān),Billroth Ⅰ吻合術(shù)手術(shù)最為簡單,手術(shù)時(shí)長及術(shù)中的出血量最少,而Roux-en-Y吻合術(shù)操作最為復(fù)雜,手術(shù)時(shí)長及術(shù)中出血量最多,Roux-en-Y吻合組拔管時(shí)間、經(jīng)口進(jìn)食時(shí)間、住院天數(shù)均較Billroth Ⅰ吻合術(shù)延長(P0.05);Roux-en-Y吻合組拔管時(shí)間和經(jīng)口進(jìn)食時(shí)間與Billroth Ⅱ組相比較也更長,差異表現(xiàn)出統(tǒng)計(jì)學(xué)意義(P0.05).3.三組病人術(shù)后6月Chew-wun Wu特殊癥狀量表評分?jǐn)?shù)據(jù)顯示:Roux-en-Y吻合組與Billroth Ⅰ吻合及Billroth Ⅱ吻合組分別比較,其中反流燒心感項(xiàng)的評分(Billroth Ⅰ吻合:1.69±0.31;Billroth Ⅱ吻合:1.58±0.49;Roux-en-Y吻合:2.15±0.63),低于另外兩組,P0.05,有統(tǒng)計(jì)學(xué)意義。其他癥狀評分未見明顯差異。4.三組病人術(shù)后1年內(nèi)并發(fā)癥Roux-en-Y組與Billroth-I組并發(fā)癥差異經(jīng)卡方檢驗(yàn)在膽汁反流、傾倒綜合征、殘胃炎、反流性食管炎方面P0.05,發(fā)生率更低,有統(tǒng)計(jì)學(xué)意義,其他并發(fā)癥差異無統(tǒng)計(jì)學(xué)意義(P0.05),而Billroth Ⅱ組各種并發(fā)癥的發(fā)生情況除內(nèi)疝和輸入襻梗阻外較Roux-en-Y組或Billroth-I組高(P均0.05)。結(jié)論:遠(yuǎn)端胃癌根治術(shù)后常用的三種消化道重建方式各有長短利弊,基于迄今的臨床證據(jù),Billroth Ⅰ式操作簡單,有條件時(shí)應(yīng)為首選;Billroth Ⅱ式操作比Roux-en-Y式簡捷,但并發(fā)癥多;Roux-en-Y手術(shù)操作復(fù)雜,胃腸功能恢復(fù)慢。但重建抗反流作用顯著優(yōu)于Billroth Ⅰ式及Billroth Ⅱ式重建,遠(yuǎn)期病人生活質(zhì)量良好,值得推廣使用。
[Abstract]:Background: data show that the incidence of gastric cancer patients in China is the second highest in the world. About 679100 people are newly diagnosed with gastric cancer and 498000 people die of gastric cancer each year. Among them, distal gastric cancer accounts for about 50%. so far the only means to cure gastric cancer is only comprehensive surgery guided by surgery. After radical gastrectomy, the digestive tract is carried out. The method of reconstruction has been varied after years of improvement. Among them, there are three main methods of kissing most commonly used after radical resection of distal gastric cancer in China, which are Billroth I, Billroth II and Roux-en-Y. The three kinds of anastomosis have both advantages and disadvantages. At present, there are no clinically recognized best choices. This article is about the postoperative elimination of three kinds of gastric cancer. In order to provide clinical basis for the rational selection of digestive tract reconstruction after radical resection of distal gastric cancer, the clinical data of three kinds of common digestive tract reconstruction after radical resection of distal gastric cancer were analyzed. Methods: from September 2014 to March 2016, the patients with digestive tract reconstruction after radical gastrectomy of gastric cancer in the gastrointestinal surgery department of China Yuru Hospital of Jilin University from September 2014 to March 2016 were selected. The patients had no history of abdominal surgery. The preoperative CT, ultrasound and other auxiliary examinations had no distant metastasis. The preoperative adjustment of the body state could be tolerated and the distal radical gastrectomy was performed. The postoperative pathology was consistent with the preoperative pathology. There were 87 cases in the group of patients, including 22 cases of Billroth I, 32 cases of Billroth II, and 33 cases of Roux-en-Y anastomosis. Between (min), intraoperative bleeding (ML), recovery time of gastrointestinal function (d), postoperative hospital stay (d), postoperative recovery of digestive tract function, follow-up investigation of special symptom scale in June after operation and 1 year postoperative complications. Results: 1. and three groups of patients were in age, sex, pathological category and TNM staging. No significant difference (P0.05) was found (P0.05). There was no statistical significance. There was a positive correlation between the operation time and the amount of intraoperative bleeding and the complexity of the operation. The Billroth I anastomosis was the most simple, the operation was the least, and the Roux-en-Y anastomosis was the most complicated, and the operation was long. And the amount of bleeding in the operation was the most. The time of extubation in the Roux-en-Y anastomosis group was longer than that of the Billroth I anastomosis (P0.05), and the time of extubation and the feeding time of the Roux-en-Y anastomosis group were also longer than those of the Billroth II group. The difference showed that the patients in the group of.3. three were statistically significant in the June Chew-wun Wu disorder after the operation. The scale score data showed that Roux-en-Y anastomosis group and Billroth I anastomosis and Billroth II anastomosis group were compared respectively, in which the score of reflux heart burning (Billroth I anastomosis: 1.69 + 0.31; Billroth II anastomosis: 1.58 + 0.49; Roux-en-Y anastomosis: 2.15 + 0.63), lower than the other two groups, P0.05, with statistical significance. Other symptoms score was not clear. The difference of complications between group Roux-en-Y and group Billroth-I in group.4. three after 1 years, the difference of complications between group Roux-en-Y and group Billroth-I by chi square test in bile reflux, dump syndrome, remnant gastritis and reflux esophagitis was lower and statistically significant. There was no statistical significance in other complications (P0.05), and the incidence of various complications in group Billroth II. The results were higher than that of group Roux-en-Y or group Billroth-I (P 0.05). Conclusion: the three kinds of digestive tract reconstruction after radical resection of distal gastric cancer have advantages and disadvantages. Based on the clinical evidence to date, the operation of Billroth I is simple and the condition should be the first choice; Billroth II operation is simpler than Roux-en-Y type. There are many complications. The operation of Roux-en-Y is complicated and the function of gastrointestinal recovery is slow. However, the reconstructive anti reflux effect is better than that of Billroth I and Billroth II reconstruction. The quality of life of the long term patients is good, and it is worth popularizing.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R735.2

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