Osugi H, Fukuhara K, Takada N, Takemura M, Kinoshita H
Department of Gastroenterological Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan.
Hepatogastroenterology. 2004 Jul-Aug;51(58):1215-8.
BACKGROUND/AIMS: Gastroduodenostomy (Billroth I) or gastrojejunostomy (Billroth II) after distal gastrectomy is associated with duodenogastric reflux and remnant gastritis. This study sought to determine which reconstructive procedure is least likely to cause remnant gastritis and to determine the correlation between duodenogastric reflux and remnant gastritis.
Sixty patients who underwent curative distal gastrectomy for gastric cancer were classified into three groups by reconstructive procedure: group A, Roux-Y (n=18); group B, Billroth I (n=25); group C, Billroth II (n=17). Intragastric bile reflux was monitored using the Bilitec 2000 14 days after surgery, and endoscopy was performed and a patient questionnaire was completed 12 weeks after surgery.
Bile reflux occurred in 23.9%, 40.4%, and 73.4% of the time (p<0.001), and remnant gastritis developed in 33%, 76%, and 100% of patients (p<0.001), in groups A, B, and C, respectively. Helicobacter pylori infection did not correlate with remnant gastritis (p=0.57). Symptoms following Roux-Y reconstruction were comparable to those following Billroth I and II reconstructions.
Roux-Y reconstruction following distal gastrectomy is superior to Billroth I and II reconstruction in preventing remnant gastritis because it reduces duodenogastric reflux.
背景/目的：远端胃切除术后行胃十二指肠吻合术（毕Ⅰ式）或胃空肠吻合术（毕Ⅱ式）与十二指肠胃反流及残胃炎相关。本研究旨在确定哪种重建手术最不可能引起残胃炎，并确定十二指肠胃反流与残胃炎之间的相关性。
60例行胃癌根治性远端胃切除术的患者按重建手术方式分为三组：A组，Roux-Y吻合术（n = 18）；B组，毕Ⅰ式（n = 25）；C组，毕Ⅱ式（n = 17）。术后14天使用Bilitec 2000监测胃内胆汁反流情况，术后12周进行内镜检查并完成患者问卷调查。
A组、B组和C组胆汁反流发生率分别为23.9%、40.4%和73.4%（p<0.001），残胃炎发生率分别为33%、76%和100%（p<0.001）。幽门螺杆菌感染与残胃炎无相关性（p = 0.57）。Roux-Y重建术后的症状与毕Ⅰ式和毕Ⅱ式重建术后相当。
远端胃切除术后Roux-Y重建术在预防残胃炎方面优于毕Ⅰ式和毕Ⅱ式重建术，因为它可减少十二指肠胃反流。
