Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan.
J Gastroenterol Hepatol. 2018 Feb;33(2):418-425. doi: 10.1111/jgh.13910.
No study has compared the incidence of postoperative bone metabolic disorders between Billroth-I (B-I) and Roux-en-Y (R-Y) reconstructions after distal gastrectomy (DG) for gastric cancer (GC). In this study, we wished to examine the impact of reconstruction method on postoperative bone mineral density (BMD) loss.
We investigated a total of 148 consecutive patients who underwent DG with B-I or R-Y reconstruction for stage I GC between 2008 and 2012. We retrospectively assessed the BMD data using computed tomography attenuation values of the first lumbar vertebra after surgery.
In multivariate analysis for the whole study series, R-Y reconstruction was identified as an independent risk factor for BMD loss after DG (P < 0.0001; OR = 5.60; 95% CI = 2.38-13.98). Propensity score match analysis was used to overcome bias because of the different covariates for the two groups; even though the 37 patients in the B-I group and the 37 patients in the R-Y group had no significant difference among characteristics, B-I reconstruction was validated to have superiority over R-Y reconstruction for preventing BMD loss in the first 3 years after DG. The cumulative hazard ratio of osteoporosis after gastrectomy was significantly higher in the R-Y group than in the B-I group (P = 0.0427).
Billroth-I reconstruction might be a preferable method for preventing BMD loss after gastrectomy in GC patients.
尚无研究比较胃癌行远端胃大部切除术后毕罗氏Ⅰ式（Billroth-I，B-I）和毕罗氏Ⅱ式（Roux-en-Y，R-Y）重建对术后骨代谢紊乱发生率的影响。本研究旨在探讨重建方法对术后骨密度（bone mineral density，BMD）丢失的影响。
我们回顾性分析了 2008 年至 2012 年间 148 例行 B-I 或 R-Y 重建的 I 期胃癌患者的资料。采用术后腰椎第 1 椎体计算机断层衰减值评估 BMD 数据。
多因素分析显示，R-Y 重建是 DG 后 BMD 丢失的独立危险因素（P<0.0001；OR=5.60；95%CI=2.38-13.98）。为了克服两组间不同协变量的偏倚，采用倾向性评分匹配分析；即使 B-I 组的 37 例患者和 R-Y 组的 37 例患者在特征方面无显著差异，B-I 重建仍被证实优于 R-Y 重建，可在 DG 后 3 年内预防 BMD 丢失。R-Y 组的术后骨质疏松累积风险比明显高于 B-I 组（P=0.0427）。
B-I 重建可能是预防胃癌患者胃切除术后 BMD 丢失的更好方法。
