摘要目的：比较远端胃癌根治性切除毕Ⅰ式与毕Ⅱ式吻合术后并发症及远期生存情况。方法回顾性分析2008年5月至2015年4月期间第四军医大学西京医院消化外科收治的992例行D2根治性远端胃切除术患者的临床资料，其中毕Ⅰ式吻合207例（毕Ⅰ组），毕Ⅱ式吻合785例（毕Ⅱ组）。采用SAS9．3软件，以年龄（±10岁）、性别、肿瘤大小（±1 cm）、病理类型、浸润深度为匹配变量，对毕Ⅰ组和毕Ⅱ组病例行gmatch配对，减少组间病理特征差异，成功匹配191对患者。比较两组患者术后并发症发生率和3年总体生存率。结果两组患者年龄、性别、肿瘤大小、病理类型、浸润深度、淋巴结转移及TNM分期等基线资料的差异均无统计学意义（P ＞0.05）。毕Ⅰ组较毕Ⅱ组，手术时间缩短[（181．7±57．0） min比（220．7±68．8） min， t＝－6．038， P＝0．000]，住院时间也较短[（7．6±2．7） d比（8．1±2．8） d， t＝－1．920， P＝0．046]。两组患者间术后并发症包括吻合口瘘、切口裂开、切口感染、腹腔出血、肠梗阻、十二指肠残端瘘、呼吸道感染和发热等发生率的差异无统计学差异（均P >0.05）。毕Ⅰ组与毕Ⅱ组患者的3年生存率分别为82．9％和78．7％，差异无统计学意义（P ＝0．379）。结论与毕Ⅱ式相比，毕Ⅰ式吻合作为根治性远端胃切除术的吻合方式更为适宜。

abstractsObjective To compare the long-term survival and postoperative complications of distal gastric cancer patients between Billroth Ⅰ (BⅠ) and Billroth Ⅱ (BⅡ) reconstruction. Methods Clinicopathological data of 992 patients with distal gastric cancer who underwent D2 curative gastrectomy in our department from May 2008 to April 2015 were recorded , including 207 patients of BⅠ reconstruction and 785 of BⅡ reconstruction, were retrospectively analyzed. Patients presenting a previous history of cancer, gastric resection or cytotoxic chemotherapy, and those presenting liver or intraperitoneal tumor dissemination or unresectable infiltration into contiguous organs were excluded. Patients in BⅠ and BⅡ group were selected using gmatch methods based on age (±10 years), gender, tumor size (±1 cm), differentiated degree and depth of invasion in order to reduce the selection bias of clinicopathological characteristics. The final number of patients matched was 191 respectively. Results Compared with BⅡ group, the BⅠ group had a significantly shorter operation time (181.7 min vs. 220.7 min, P = 0.000) and a shorter postoperative hospitalization stay (7.6 days vs. 8.1 days, P = 0.046). The postoperative complications including anastomotic leakage, wound dehiscence, wound infection, intraperitoneal hemorrhage, intestinal obstruction, duodenal stump fistula, pulmonary infection and fever had no significant difference (P > 0.05). Three-year survival between two groups was comparable (82.9%vs. 78.7%, P=0.379). Conclusions Compared with BⅡ, BⅠ reconstruction is more suitable for patients with distal gastric cancer.