中国实用外科杂志2024，Vol.44Issue(10)：1149-1154,6.DOI:10.19538/j.cjps.issn1005-2208.2024.10.14
基于倾向性评分匹配对比腹腔镜远端胃切除术改良与传统Billroth Ⅱ式吻合的临床效果
Comparison of the efficacy of modified Billroth Ⅱ versus traditional Billroth Ⅱ anastomosis in laparoscopic distal gastrectomy based on propensity score matching analysis
摘要
Abstract
Objective To analyze the clinical effects of using modified Billroth Ⅱ anastomosis(R-method anastomosis)and traditional Billroth Ⅱ anastomosis to complete gastrointestinal reconstruction in laparoscopic distal gastrectomy for gastric cancer.Methods A retrospective analysis was conducted using propensity score matching on the clinical and pathological data from 445 patients diagnosed with gastric cancer who underwent laparoscopic distal gastrectomy at Subei People's Hospital in Jiangsu Province from July 2020 to March 2023.Patients were divided into two groups based on the gastrojejunostomy anastomosis method.Among them,115 patients underwent R-method gastrojejunostomy(R group)while 330 patients underwent the traditional method(traditional group).The traditional group was further categorized into simple BillrothⅡ anastomosis(B2 subgroup with 116 patients)and Billroth Ⅱ+Braun anastomosis(B+B subgroup with 114 patients).Surgical-related indicators and incidence of complications were compared between these groups.Results All patients successfully received the surgery.The anastomosis time of the R group(31.3±4.4)min was shorter than that of the traditional group(33.9±5.5)min,B2 subgroup(34.6±5.1)min,and B+B subgroup(33.3±5.8)min,and the difference was statistically significant(P＜0.05).There was no statistically significant difference in intraoperative bleeding,number of lymph node dissections,postoperative exhaust time,gastric tube retention time,inflow food time,and postoperative hospitalization time(P＞0.05).In terms of postoperative complications,no anastomotic stenosis occurred in the R group,while 7 cases(7.3％)occurred in the traditional group,with a statistically significant difference(P＜0.05).Only one case of gastric paralysis(grade A)occurred in the R group after surgery while 11 cases(grade A 8 cases,grade B 3 cases)occurred in the traditional group,with statistically significant differences in incidence(x2=8.889,P=0.003)and severity(x2=10.912,P=0.004).Conclusion The R-method gastrojejunostomy,when employed in laparoscopic distal gastrectomy for gastric cancer based on Billroth Ⅱ anastomosis,effectively reduces anastomosis time and decreases the occurrence of postoperative anastomotic stenosis and gastric emptying dysfunction,worth wide clinical application in this context.关键词
腹腔镜/远端胃切除术/Billroth Ⅱ式吻合/吻合时间/吻合口狭窄Key words
laparoscopy/distal gastrectomy/Billroth Ⅱ anastomosis/anastomosis time/anastomosis stenosis分类
医药卫生引用本文复制引用
姜明瑞,王道荣,周家杰,孙龙和,嵇晋,山海,王伟,任俊,汤东,汪刘华..基于倾向性评分匹配对比腹腔镜远端胃切除术改良与传统Billroth Ⅱ式吻合的临床效果[J].中国实用外科杂志,2024,44(10):1149-1154,6.基金项目
国家自然科学基金项目(No.82373014) （No.82373014）
