Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Shanghai Minimally Invasive Surgery Center, Shanghai, China.
Ann Surg Oncol. 2022 Apr;29(4):2359-2367. doi: 10.1245/s10434-021-11187-4. Epub 2022 Jan 7.
This retrospective study aimed to compare the feasibility and effectiveness of a modified Billroth-II with Braun (B-II Braun) reconstruction and those of a Roux-en-Y (R-Y) reconstruction after laparoscopic distal gastrectomy.
From January 2016 to December 2019, 247 patients underwent total laparoscopic distal gastrectomy (TLDG), with B-II Braun reconstruction for 145 patients and R-Y reconstruction for 102 patients. The patients' data were collected prospectively and reviewed retrospectively.
In this study, the median times of the operation were statistically shorter for B-II Braun than for R-Y (167 min [range, 110-331 min] vs 191 min [range, 123-384 min]; p = 0.001), including anastomotic times (33 min [range, 30-42 min] vs 42 min [range, 40-48 min]; p = 0.001). After a short-term follow-up period, endoscopy showed 31 cases of bile reflux (21.4%), 15 cases of grade 2 gastritis (10.3%), and 6 cases of grade 2 food residue (4.1%) in the B-II Braun group after 6 months. After 1 year, 10 patients (6.9%) had grade 2 gastritis and 2 patients (1.4%) had grade 3 gastritis. However, the remnant stomach of the two groups did not differ significantly in the rate of gastric residue (p = 0.112 after 6 months; p = 0.579 after 1 year, respectively), gastritis (p = 0.726 after 6 months; p = 0.261 after 1 year, respectively), or bile reflux (p = 0.262 after 6 months; p = 0.349 after 1 year, respectively).
For gastric cancer patients, TLDG with modified B-II Braun reconstruction could be technically feasible. It has an acceptable range of postoperative complications and is effective in preventing bile reflux into the gastric remnant.
本回顾性研究旨在比较腹腔镜下远端胃切除术后改良 Billroth-II 与 Braun（B-II Braun）重建和 Roux-en-Y（R-Y）重建的可行性和效果。
2016 年 1 月至 2019 年 12 月，247 例患者接受全腹腔镜下远端胃切除术（TLDG），其中 145 例患者行 B-II Braun 重建，102 例患者行 R-Y 重建。前瞻性收集患者资料并进行回顾性分析。
本研究中，B-II Braun 组的手术时间中位数明显短于 R-Y 组（167 分钟[范围：110-331 分钟]比 191 分钟[范围：123-384 分钟]；p=0.001），包括吻合时间（33 分钟[范围：30-42 分钟]比 42 分钟[范围：40-48 分钟]；p=0.001）。短期随访后，内镜显示 B-II Braun 组 6 个月时胆汁反流 31 例（21.4%），2 级胃炎 15 例（10.3%），2 级食物残留 6 例（4.1%）。术后 1 年，10 例（6.9%）患者出现 2 级胃炎，2 例（1.4%）患者出现 3 级胃炎。然而，两组残胃的胃潴留率差异无统计学意义（6 个月时 p=0.112；1 年时 p=0.579），胃炎发生率（6 个月时 p=0.726；1 年时 p=0.261）和胆汁反流发生率（6 个月时 p=0.262；1 年时 p=0.349）差异均无统计学意义。
对于胃癌患者，腹腔镜下改良 B-II Braun 重建是一种可行的技术，术后并发症的发生范围可接受，可有效预防胆汁反流至残胃。
