Department of Surgery, Daisan Hospital, The Jikei University School of Medicine, 4-11-1, Izumihon-cho, Komae-si, Tokyo, 201-8601, Japan.
J Gastrointest Surg. 2012 Jun;16(6):1102-6. doi: 10.1007/s11605-012-1850-5. Epub 2012 Mar 6.
We herein report the short-term results of the newly developed modified technique of Billroth I (modified B-I; pylorus reconstruction) that prevents duodenogastric reflux (DGR) and remnant gastritis after distal gastrectomy.
Distal gastrectomy with this technique was performed in 20 patients (age, 41 to 86 years [mean, 68.5 ± 11.8 years], male/female = 12:8) with gastric cancer from June 2006 through December 2009. These patients were compared with another 20 patients who underwent conventional B-I after distal gastrectomy (age, 41 to 85 years [mean, 69.3 ± 8.69 years], male/female = 11:9). The side effects of gastric surgery evaluated in this study were the degree of remnant gastritis, the presence of dumping syndrome, and the degree of weight loss.
By gastrografin contrast imaging on the fifth day after pylorus reconstruction, the remnant stomach was not dilated and gastrografin flowed physiologically to the duodenum without backward reflux into the remnant stomach. By gastroscopy at 6 months after the operation, DGR and the degree of remnant gastritis after pylorus reconstruction was lower than those of conventional B-I (P = 0.00068). The bile acid concentration of remnant gastric juice of pylorus reconstruction was lower than that of conventional B-I (55.5 ± 93.5 vs. 1,369.5 ± 2,502.1 μmol/L, P = 0.0415). Weight loss at 1 year after distal gastrectomy was less in pylorus reconstruction compared with conventional B-I (6.2 ± 5.2% vs. 9.8 ± 8.7%, P = 0.0725).
Pylorus reconstruction is a simple and safe anastomotic technique that reduces the side effects of B-I reconstruction.
我们在此报告新开发的改良毕罗氏 I 型（改良 B-I；幽门重建）技术的短期结果，该技术可预防远端胃切除术后的十二指肠胃反流（DGR）和残胃炎。
2006 年 6 月至 2009 年 12 月，我们对 20 例胃癌患者（年龄 41 至 86 岁[平均 68.5±11.8 岁]，男/女=12:8）行此技术的远端胃切除术。将这些患者与 20 例行传统毕罗氏 I 型远端胃切除术后的患者（年龄 41 至 85 岁[平均 69.3±8.69 岁]，男/女=11:9）进行比较。本研究评估的胃手术后的副作用为残胃炎程度、倾倒综合征的存在和体重减轻程度。
通过幽门重建后第 5 天的胃造影对比成像，残胃未扩张，胃造影剂生理性地流入十二指肠，而无向后反流至残胃。术后 6 个月行胃镜检查，幽门重建后的 DGR 和残胃炎程度低于传统 B-I（P=0.00068）。幽门重建残胃胆汁酸浓度低于传统 B-I（55.5±93.5 与 1369.5±2502.1 μmol/L，P=0.0415）。与传统 B-I 相比，远端胃切除术后 1 年的体重减轻较少（6.2±5.2%比 9.8±8.7%，P=0.0725）。
幽门重建是一种简单安全的吻合技术，可减少毕罗氏 I 型重建的副作用。
