Total Laparoscopic Uncut Roux-en-Y for Radical Distal Gastrectomy: An Interim Analysis of a Randomized, Controlled, Clinical Trial
Total Laparoscopic Uncut Roux-en-Y for Radical Distal Gastrectomy: An Interim Analysis of a Randomized, Controlled, Clinical Trial
复制标题
全腹腔镜未切割 Roux-en-Y 根治性远端胃切除术：随机对照临床试验的中期分析
DOI：
10.1245/s10434-020-08710-4
复制
发表时间：
2020-06-18
影响因子：
3.7
通讯作者：
Ji, Gang
中科院分区：
文献类型：
--
作者：
Wang, Juan;Wang, Quan;Ji, Gang
背景胃癌腹腔镜远端胃切除术后传统的Billroth II和Roux-en-Y吻合术分别与胆汁反流性胃炎和Roux淤滞综合征相关。不切开的胃空肠Roux-en-Y吻合术通过阻断胆汁和胰液进入残胃，保留十二指肠的动力，可以减少这些并发症的发生。本研究的目的是比较非切割Roux-en-Y（URY）和Billroth II联合Braun（BB）吻合术的短期结局。方法采用前瞻性、多中心、随机双盲对照研究方法，将124例晚期远端胃癌患者随机分为URY组（n = 62）和BB组（n = 62）。结果URY组胃液pH值明显低于BB组（3.94 ± 0.71 vs.5.83 ± 0.91，P < 0.0001）; BB组3个月（P < 0.0001）和6个月（P = 0.002）时胆汁反流性胃炎的发生率明显高于BB组。URY组未发生再通，两组平均手术时间无明显差异（P = 0.69），平均吻合时间（P = 0.86），平均估计失血量（P = 0.77），平均收获淋巴结数量（P = 0.90），至首次排气或排便的时间（P = 0.87）、术后住院时间（P = 0.83）和术后并发症发生率（P = 0.70）。结论URY吻合术与BB吻合术相比，胆汁反流性胃炎和Roux淤滞综合征的发生率明显降低。
Background The traditional Billroth II and Roux-en-Y anastomosis after laparoscopic distal gastrectomy for gastric cancer are associated with bile reflux gastritis and roux stasis syndrome, respectively. The uncut Roux-en-Y gastrojejunostomy can decrease the incidence of these complications by blocking the entry of bile and pancreatic juice into the residual stomach and retaining the impulses originating from the duodenum. The purpose of the present study was to compare the short-term outcomes of uncut Roux-en-Y (URY) and Billroth II combined Braun (BB) anastomosis. Methods In this prospective, multi-center, two-arm randomized controlled trial, 124 patients with advanced distal gastric cancer were randomized into two groups: URY (n = 62) and BB (n = 62) groups. Results The mean gastric juice pH was significantly lower in the URY group compared with the BB group (3.94 +/- 0.71 vs. 5.83 +/- 0.91,P < 0.0001). The bile reflux gastritis at 3 months (P < 0.0001) and 6 months (P = 0.002) was significantly more frequent in the BB group. No recanalization occurred in the URY group, and no significant difference was found between the two groups in terms of mean operative time (P = 0.69), mean time to perform anastomosis (P = 0.86), mean estimated blood loss (P = 0.77), mean number of harvested lymph nodes (P = 0.90), time to first passage of flatus or defecation (P = 0.87), postoperative hospital stay (P = 0.83), and the incidence of postoperative complications (P = 0.70). Conclusions URY anastomosis is associated with a significantly lower incidence of bile reflux gastritis and roux stasis syndrome compared with BB anastomosis.