目的:为了评估BillrothI(B-I)的短期影响,BillrothⅡ(B-Ⅱ),BillrothⅡ+Braun(B-B),和Roux-en-Y(R-Y)重建在根治性远端胃切除术中使用倾向评分匹配(PSM)。
方法:回顾性分析近10年来1994例远端胃癌根治术患者的临床资料。随后,对4个重建程序进行了3次PSM分析,匹配容量设置为0.01。比较和分析了使用PSM获得的有关控制变量和结果指标的数据。
结果:与其他重建程序相比,B-I组患者手术时间较短(P=0.002),腹腔引流管较少(P<0.001),术后胃瘫(P=0.001)和消化道出血(P=0.034)的风险较低,但术后膀胱导管留置时间较长(P<0.001),胃肠减压(P<0.001),空腹(P=0.001),住院时间(P=0.005)。B-B组的腹腔引流管应用较少(P=0.014),术后胃肠瘘的风险较低(P=0.040),术后胃肠减压时间较短(P=0.043),空腹(P<0.001),与R-Y组相比,住院时间更短(P<0.001)。此外,B-B组术后胃肠减压时间(P=0.014)和禁食时间(P<0.001)均短于B-Ⅱ组。
结论:BillrothI重建具有操作简单的优点,手术时间短,很少有早期并发症,但往往会导致术后住院期间恢复时间长。B-B手术比R-Y或B-Ⅱ手术术后恢复快。
OBJECTIVE: To evaluate the short-term effects of Billroth I (B-I), Billroth Ⅱ (B-Ⅱ), Billroth Ⅱ+Braun (B-B), and Roux-en-Y (R-Y) reconstruction procedures in radical distal gastrectomy using propensity score matching (PSM).
METHODS: The clinical data of 1994 patients who underwent radical distal gastrectomy in the past 10 years were retrospectively analyzed. Subsequently, PSM analyses were performed 3 times on the 4 reconstruction procedures, and the matching capacity was set to 0.01. Data regarding control variables and outcome indicators obtained using PSM were compared and analyzed.
RESULTS: Compared with the other reconstruction procedures, patients in the B-I group had shorter operation time ( P =0.002), fewer abdominal drainage tubes ( P <0.001), and a lower risk of postoperative gastroparesis ( P =0.001) and gastrointestinal bleeding ( P =0.034), but tended to experience a longer postoperative indwelling time of bladder catheter ( P <0.001), gastrointestinal decompression ( P <0.001), fasting ( P =0.001), and hospital stays ( P =0.005). The B-B group tended to have fewer applications of the abdominal drainage tube ( P =0.014), a lower risk of postoperative gastrointestinal fistula ( P =0.040), shorter postoperative time of gastrointestinal decompression ( P =0.043), fasting ( P <0.001), and a shorter hospital stay ( P <0.001) than the R-Y group. Furthermore, the B-B group had a shorter postoperative time for gastrointestinal decompression ( P =0.014) and fasting ( P <0.001) than the B-Ⅱ group.
CONCLUSIONS: Billroth I reconstruction has the advantages of simple operation, short operative time, and few early complications, but tends to result in a long recovery time during postoperative hospitalization. The B-B operation is associated with faster postoperative recovery than the R-Y or B-Ⅱ operation.