胃空肠裤形吻合与Billroth II (BII)式吻合在腹腔镜辅助远端胃癌根治术中的比较研究

Comparative Study on Pants-Shaped Gastrojejunostomy versus Billroth II Anastomosis in Laparoscopy-Assisted Distal Gastrectomy for Gastric Cancer

摘要: 目的：比较腹腔镜辅助远端胃癌根治术中胃空肠裤形吻合与Billroth II (BII)式吻合的围手术期安全性与近期疗效。方法：采用回顾性队列研究，收集我院行腹腔镜辅助远端胃癌根治术的33例患者资料，根据重建方式分为裤形吻合组(14例)与BII式吻合组(19例)。比较两组术前基线、术中指标及术后并发症。结果：两组基线资料均衡。裤形吻合组手术时间显著短于BII式吻合组[(3.17 ± 0.65) h vs. (3.86 ± 0.85) h，P = 0.018]，术中出血量无显著差异[(55.0 ± 24.7) mL vs. (69.4 ± 58.1) mL, P = 0.395]。术后首次排气时间、首次流质饮食时间及术后住院天数两组间比较，差异均无统计学意义(P > 0.05)。裤形吻合组并发症发生率为21.4% (3/14)，B II式吻合组为31.6% (6/19)，差异无统计学意义(P = 0.686)。结论：在腹腔镜远端胃癌根治术中，胃空肠裤形吻合可缩短手术时间，且不增加术中出血及术后短期并发症风险，其近期安全性与疗效与B II式吻合相当。

Abstract: Objective: This paper aims to compare the perioperative safety and short-term outcomes between pants-shaped gastrojejunostomy and Billroth II (BII) anastomosis in laparoscopy-assisted distal gastrectomy (LADG) for gastric cancer. Methods: A retrospective cohort study was conducted on 33 patients who underwent LADG with lymphadenectomy. Based on the reconstruction method, patients were divided into the pants-shaped anastomosis group (n = 14) and the BII anastomosis group (n = 19). The preoperative baseline, intraoperative indicators, and postoperative complications were compared. Results: The baseline characteristics were comparable between the two groups. The operative time in the pants-shaped group was significantly shorter than that in the BII group [(3.17 ± 0.65) h vs. (3.86 ± 0.85) h, P = 0.018]. No significant difference was found in intraoperative blood loss [(55.0 ± 24.7) mL vs. (69.4 ± 58.1) mL, P = 0.395]. There were no significant differences in the time to first flatus, time to first liquid diet, or postoperative hospital stay (P > 0.05). The complication rates were 21.4% (3/14) in the pants-shaped group and 31.6% (6/19) in the BII group, with no statistical significance (P = 0.686). Conclusion: In LADG, pants-shaped gastrojejunostomy can shorten the operative time without increasing the risk of intraoperative bleeding or short-term postoperative complications. Its short-term safety and efficacy are comparable to those of the BII anastomosis.