目的

探究不同吻合术对腹腔镜远端胃癌根治术患者的影响。

方法

回顾性分析2022年9月至2023年4 月110例腹腔镜远端胃癌根治术患者资料，根据吻合方式不同分为非离断组（行非离断Roux-en-Y吻合）与毕Ⅱ组（行BillrothⅡ+ Braun吻合），倾向性匹配排除基线资料混杂因素，两组各得55例患者。采用SPSS22.0软件分析数据。术后并发症、反流情况等计数资料以［例（%）］表示，行χ²检验或秩和检验；围手术期指标、肠道屏障指标、生存期等计量资料以（±s）表示，行独立样本t检验。P＜0.05为差异具有统计学意义。

结果

非离断组患者手术时间、术中出血量显著高于毕Ⅱ组（P＜0.05）；非离断组患者并发症发生率（3.6%）与毕Ⅱ组（12.7%）比较差异无统计学意义（P＞0.05）；术后3d，肠道屏障功能指标两组患者D-乳酸、二胺氧化酶（DAO）水平显著提高（P＜0.05），且非离断组显著高于毕Ⅱ组（P＜0.05）；非离断组患者胆汁反流及反流性胃炎情况显著优于毕Ⅱ组（P＜0.05）；随访1年，两组患者无进展生存期（PFS）（Log-Rankχ²=0.529，P=0.467），两组患者总生存期（OS）（Log-Rankχ²=0.339，P=0.560），差异均无统计学意义。

结论

非离断Roux-en-Y吻合与BillrothⅡ+ Braun吻合术均可有效重建腹腔镜远端胃癌根治术患者消化道，非离断Roux-en-Y吻合在改善胃肠道功能、抗反流等方面更具优势。

Objective

To explore the influence of different anastomosis techniques on patients undergoing laparoscopic radical distal gastrectomy.

Methods

The data of 110 patients who underwent laparoscopic radical distal gastrectomy from September 2022 to April 2023 were retrospectively analyzed.According to different anastomosis methods，they were divided into the non-transection group （undergoing nontransection Roux-en-Y anastomosis） and the Billroth II group （undergoing Billroth II + Braun anastomosis）.Propensity matching was used to exclude confounding factors in the baseline data，and 55 patients were obtained in each group.The SPSS22.0 software was used for data analysis.Count data such as postoperative complications and the situation of reflux were expressed as［ cases （%）］，and the χ² test or Rank Sum test was performed.Measurement data such as perioperative indexes，intestinal barrier indexes，and survival periods were expressed as （±s），and the independent sample t test was carried out.A P value less than 0.05 indicated a statistically significant difference.

Results

The operation time and intraoperative blood loss of patients in the non-transection group were significantly higher than those in the Billroth II group （P＜0.05）.There was no statistically significant difference in the complication rate between the non-transection group （3.6%） and the Billroth II group （12.7%） （P＞0.05）.Three days after surgery，the levels of D-lactic acid and diamine oxidase（DAO），which were indexes of intestinal barrier function，increased significantly in both groups （P＜0.05），and the levels in the non-transection group were significantly higher than those in the Billroth II group （P＜0.05）.The situations of bile reflux and reflux gastritis in patients of the non-transection group were significantly better than those in the Billroth II group （P＜0.05）.After 1-year follow-up，there were no statistically significant differences in the progression-free survival （PFS） between the two groups （Log-Rankχ²=0.529，P=0.467）and in the overall survival （OS） between the two groups （Log-Rankχ²=0.339，P=0.560）.

Conclusion

Both non-transection Roux-en-Y anastomosis and Billroth II + Braun anastomosis can effectively reconstruct the digestive tract of patients undergoing laparoscopic radical distal gastrectomy.Non-transection Roux-en-Y anastomosis has more advantages in aspects such as improving gastrointestinal function and anti-reflux.