摘要
目的比较远端胃切除术后行Billroth I(B-Ⅰ,毕Ⅰ)式重建手术和Roux-en-Y(RY)重建手术病人的术后结果及临床疗效。方法选择53例病人分为B-Ⅰ重建组(n=28)及RY重建组(n=25),对其并发症、术后住院时间进行比较；术后6个月随访内镜评估残胃的胆汁反流及感染和食管下端的状况。结果两组在手术时间、失血量比较,差异无统计学意义(P＞0．05)。行RY重建手术的25例病人术后住院时间为(18．00±5．20)d,B-Ⅰ组病人术后住院时间为(32．80±23．60)d,两组比较,差异有统计学意义(P＜0．05)。内镜检查显示术后残胃的感染程度RY组低于B-Ⅰ组,差异有统计学意义(P＜0．05)。然而,B-Ⅰ组中和RY组中出现食管下端感染的病人分别有8例(28．57%)和8例(32．00%)。两组比较,差异无统计学意义(P＞0．05)。结论RY重建手术能有效地阻止十二指肠胃反流及其引发的残胃炎,但不能阻止食管炎,同时RY重建手术增加了诱发梗阻的发生频率,导致术后住院时间延长,因此远端胃切除术后行RY式重建方法与B-Ⅰ式相比优势有限。
Objective To determine the clinical efficacy of Billroth I and Roux-en-Y reconstruction （RY） after distal gastrectomy. Methods A total of 53 patients were prospectively randomized to either B-I（n = 28） or RY reconstruction （n = 25） group, and complications and postoperative course were compared. Bile reflux and inflammation in the remnant stomach and lower esophagus were evaluated by postoperative follow-up endoscopy at 6 months. Results Operative time and blood loss as well as postoperative nutrition did not show significant differences between the two groups. As anticipated, 5 of 25 patients with RY reconstruction developed gastrojejunal stasis in the early postoperative period, which led to a longer postoperative hospital stay compared with the B-I group （ 18.00 ± 5.20 vs 32.80 ± 23.60 days） （ P 〈 0.05）. Endoscopic examination revealed that the degree of inflammation in the remnant stomach was lower in the RY group compared with the B-I group （P 〈 0.05） . However, inflammatory findings in the lower esophagus were observed in 8 （ 28.57% ） of B-I, and 8 （32.00%） of the RY group. Conclusion Roux-en-Y reconstruction is effective in preventing duodenogastric reflux and resulting gastritis, but it does not prevent esophagitis. Furthermore, RY reconstruction induces the frequent complication of Roux-en-Y stasis, causing longer postoperative hospital stay. This method has limited advantages over B-I anastomosis after distal gastrectomy.
出处
《全科医学临床与教育》
2006年第4期296-298,共3页
Clinical Education of General Practice
