摘要目的 评价非离断式Roux-en-Y吻合用于远端胃癌根治术后消化道重建的临床效果.方法 回顾性分析2005年3月至2008年3月间天津医科大学肿瘤医院行远端胃癌根治术且有完整随访资料的419例患者,根据其不同的消化道重建方式分为:Uncut RY组(非离断式Roux-en-Y吻合)127例,B Ⅰ组(Billroth Ⅰ式)138例,M-BⅡ组(改良Billroth Ⅱ式)108例,RY组(Roux-en-Y吻合)46例.结果 Uncut RY组患者手术时间[(132.6±19.2)min]和术后住院时间[(10.4±1.2)d]较RY组[(142.5±11.7)min和(12.1±3.7)d]缩短(P<0.05);术后反流性胃炎发生率(3.2%,4/127)较B Ⅰ组(24.6%,34/138,P<0.05)和M-BⅡ组(25.9%,28/108,P<0.05)下降;吻合口溃疡发生率(0/127)较M-BⅡ组(4.6%,5/108,P<0.05)下降;Roux-en-Y潴留综合征(RSS)发生率(0/127)较RY组(17.4%,8/46,P<0.05)下降.结论 非离断式Roux-en-Y在保留传统Roux-en-Y术式减少碱性反流优点的同时,克服了RSS的弊病,是胃大部切除术后理想的消化道重建术式.

abstractsObjective To evaluate the clinical efficacy of uncut Roux-en-Y reconstruction after distal gastrectomy for gastric cancer. Methods Clinical data of 419 patients who underwent distal gastrectomy for gastric cancer with complete follow-up data between March 2005 and March 2008 in the Cancer Institute and Hospital of Tianjin Medical University. Patients were divided into B I (138 cases with Billroth I reconstruction), M-B II (108 cases with modified Billroth II reconstruction), RY(46 cases with Roux-en-Y reconstruction) and Uncut RY(127 cases with uncut Roux-en-Y reconstruction) according to reconstructive methods. Results Patients in the Uncut RY group had a larger tumor diameter, more T3, and poorer stage of disease compared to those in the B I (P<0.05). In Uncut RY group, the operative time and postoperative hospital stay were (132.6±9.2) minutes and (10.4±1.2) days respectively,shorter than those in RY group (142.5±1.7) minutes and (12.1±3.7) days (both P<0.05), alkaline reflex gastritis rate was 3.2%, lower than that in B I group (24.6%, P<0.05) and M-B II group (25.9%,P<0.05). Marginal ulcer rate in uncut RY group was lower compared to M-B II group (P=0.019), and incidence of Roux-en-Y stasis syndrome was less compared to RY group (P=0.000). Conclusions The uncut Roux-en-Y reconstruction is both feasible and safe. It can prevent alkaline reflex gastritis and Roux-en-Y stasis syndrome. It may be the preferred technique for reconstruction after distal gastrectomy.