LIUJin-qiang 1,2 , ZHANGRui 1 , ZHOUWei 1 , ZHANGLei 1 , MAJiao-jiao 1 , YANGXue-wen 1 , XIAOShu-ao 1 , LIANXiao 1 , GUOMan 1 , ZHANGHong-wei 1 , HONGLiu 1
  • 1. Department of Digestive Surgery, Xijing Hospital of Digestive Diseases, The Fourth Military Medical University, Xi'an 710032, Shaanxi Province, China;
  • 2. Xinyang Cadres Sanatorium of Wuhan Military Logistics Base, Xinyang 464000, Henan Province, China;
HONGLiu, Email: hongliu180@126.com
Gastric cancer; Digestive tract reconstruction; Distal gastrectomy; Complication; Prognosis
10.7507/1007-9424.20160373
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Objective To investigate the ideal digestive tract reconstruction method for radical distal gastrectomy (DG). Methods Clinical and follow-up data of 862 patients with gastric cancer who underwent DG in Xijing Hospital of Digestive Diseases of The Fourth Military Medical University from January 2010 to January 2013 were analyzed retrospectively. According to reconstruction methods, patients were divided into three groups:Billroth Ⅰ group (B-Ⅰgroup), Billroth Ⅱ (B-Ⅱ)+Braun group (B-Ⅱ+Braun group), and Roux-en-Y group. In order to reduce the difference of clinicopa-thological characteristics, Gmatch method was used to select patients basing on gender, age (±5 years), tumor size (±1 cm), pT staging, and pN staging. The perioperative data, recent (30 days after surgery) complications, gastroscopic results over one year, and postoperative survival rate were compared respectively among the 3 groups. Results ① Perioperative indexes. The operative time, postoperative hospitalization, and semi liquid diet time were significantly different among 3 groups (P < 0.050). As compared with B-Ⅱ+Braun group and Roux-en-Y group, B-Ⅰ group had a significantly shorter operative time (P < 0.012 5), and there was no significant difference between B-Ⅱ+Braun group and Roux-en-Y group (P > 0.012 5). As compared with B-Ⅱ+Braun group, B-Ⅰ group had a significantly shorter semi liquid diet time (P < 0.012 5), but there was no significant difference between B-Ⅱ+Braun group and Roux-en-Y group, as well as Roux-en-Y group and B-Ⅰ group (P > 0.012 5). As compared with B-Ⅰ group and B-Ⅱ+Braun group, Roux-en-Y group had a significantly longer postoperative hospitalization (P < 0.012 5), and there was no significant difference between B-Ⅰ group and B-Ⅱ+ Braun group (P > 0.012 5). ② There was no significant difference in recent complications between Roux-en-Y group (12.5%, 4/32), B-Ⅱ+Braun (6.2%, 2/32), and B-Ⅰ group (3.1%, 1/32), P=0.495. ③ Results of endoscopic examination over 1 year after radical DG showed that there was significant difference among 3 groups (P < 0.050). Compared with B-Ⅰ group and B-Ⅱ+Braun group, the rates of reflux gastritis, bile reflux, and reflux esophagitis of Roux-en-Y group were all lower (P < 0.012 5), but there was no significant difference between B-Ⅰ group and B-Ⅱ+Braun group (P > 0.012 5).④ The 3-year survival rates of Roux-en-Y group, B-Ⅱ+Braun group, and B-Ⅰ group were 70.0% (21/30), 73.3% (22/30), and 75.0% (24/32) respectively, and there was no significant difference in the survival situation (P=0.911). Conclusions The effect of Rouxen-Y anastomosis on resisting gastrointestinal reflux is remarkable. B-Ⅰanastomosis has the advantages of more simple operation, faster recovery, and more similar to the physiological structure. Thus, B-Ⅰ anastomosis and Roux-en-Y anastomosis are recommended for digestive tract reconstruction in DG.

Citation： LIUJin-qiang, ZHANGRui, ZHOUWei, ZHANGLei, MAJiao-jiao, YANGXue-wen, XIAOShu-ao, LIANXiao, GUOMan, ZHANGHong-wei, HONGLiu. Comparison of Outcomes of Three Reconstruction Methods for Radical Distal Gastrec-tomy: A Matched Study. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2016, 23(12): 1477-1482. doi: 10.7507/1007-9424.20160373 Copy