Department of Surgery, Soonchunhyang University Bucheon Hospital, 1174, Jung-dong, Wonmi-gu, Bucheon-si, Gyeonggi-do, 420-767, Korea.
Surg Endosc. 2011 Jun;25(6):1953-61. doi: 10.1007/s00464-010-1493-0. Epub 2010 Dec 7.
Since reconstruction after laparoscopy-assisted distal gastrectomy (LADG) is performed through a small minilaparotomy window, the clinical course and complication rate are influenced by clinical technical expertise and experience. The aim of this study was to compare postoperative complications and survival rates of Billroth I and Billroth II reconstructions after LADG.
We retrospectively collected data from 1,259 patients who underwent LADG performed by ten surgeons at ten hospitals between April 1998 and December 2005. Patients were classified into two groups according to reconstruction method used: the Billroth I group (n=875) and the Billroth II group (n=384). Patient and tumor characteristics, operative details, and postoperative complications were analyzed.
Billroth II reconstruction was performed on obese patients (p=0.003) and patients with more advanced tumors (p<0.001). Billroth I reconstruction was performed more frequently in the lower portion of the stomach (p<0.001) and yielded shorter operating times. The postoperative complication rate was 11.4% in the Billroth I group, which was lower than that in the Billroth II group (16.9%) (p=0.011). However, the differences in the major complication rates were not statistically significant (p=0.263). Of the intra-abdominal complications, intraluminal or intraperitoneal bleeding was the most frequent complication in the Billroth I group and duodenal stump leakage was the most frequent in the Billroth II group. The postoperative mortality rate did not show a statistically significant difference.
Both Billroth I and Billroth II techniques are feasible and safe reconstruction methods after LADG for gastric cancer. To reduce major complication rates, surgeons should pay attention to bleeding in Billroth I reconstruction and stump leakage in Billroth II reconstruction.
由于腹腔镜辅助远端胃切除术（LADG）后的重建是通过一个小的迷你剖腹窗进行的，因此临床过程和并发症发生率受到临床技术专长和经验的影响。本研究的目的是比较 LADG 后 Billroth I 和 Billroth II 重建术后的术后并发症和生存率。
我们回顾性地收集了 1998 年 4 月至 2005 年 12 月期间由十位外科医生在十家医院进行的 1259 例 LADG 患者的数据。根据使用的重建方法，将患者分为两组：Billroth I 组（n=875）和 Billroth II 组（n=384）。分析了患者和肿瘤特征、手术细节和术后并发症。
Billroth II 重建术用于肥胖患者（p=0.003）和肿瘤更晚期的患者（p<0.001）。Billroth I 重建术在胃的下部更频繁地进行（p<0.001），并且手术时间更短。Billroth I 组的术后并发症发生率为 11.4%，低于 Billroth II 组（16.9%）（p=0.011）。但是，主要并发症发生率的差异没有统计学意义（p=0.263）。在腹腔内并发症中，Billroth I 组最常见的并发症是管腔内或腹腔内出血，而 Billroth II 组最常见的并发症是十二指肠残端漏。术后死亡率无统计学差异。
Billroth I 和 Billroth II 技术都是 LADG 治疗胃癌后的可行和安全的重建方法。为了降低主要并发症发生率，外科医生应注意 Billroth I 重建中的出血和 Billroth II 重建中的残端漏。
