새로운 Roux-en-Y 문합법에 의한 위암 수술법에 대한 고찰 : 두개의 원형 문합기를 이용하는 방법을 포함한 위아전 절제술 후 새로운 Roux-en-Y 문합법에 의한 위암 수술법에 대한 고찰 = A Novel Roux-en-Y reconstruction involving the use of two circular staplers after distal subtotal gastrectomy for gastric cancer

다국어 초록 (Multilingual Abstract)

ABSTRACT

Background: Although Roux-en-Y (R-Y) reconstruction after distal gastrectomy has several merits such as prevention of bile reflux into the remnant stomach, it is rarely used because of the technical difficulty. This study aimed to show the efficacy of a novel method of R-Y reconstruction involving the use of 2 circular staplers through a prospective randomized clinical trial comparing the novel method with Billroth-I (B-I) reconstruction.
Materials and Methods: 118 patients were randomly allocated into the RY (59 patients) and B-I reconstruction (59 patients) groups. R-Y anastomosis was performed using 2 circular staplers and no hand sewing. The primary end-point of this clinical trial was the reflux of bile into the remnant stomach, and it was evaluated through endoscopic and histological findings at 6 months after surgery.
Results: No significant differences were observed in the clinicopathologic findings between the 2 groups. Although anastomosis time (P < 0.001) was significantly longer for the patients of the R-Y group than them for the B-I group, there was no difference between the 2 groups in terms of the total surgery duration (P = 0.112). Endoscopic findings showed a significant reduction of bile reflux in the remnant stomach in the R-Y group (P < 0.001), and the histological findings showed that reflux gastritis was more significant in the B-I group than in the R-Y group (P = 0.026).

Conclusions: The results of our randomized controlled clinical trial showed that compared with B-I reconstruction, R-Y reconstruction using circular staplers is a safe and feasible procedure.

목차 (Table of Contents)

• TABLE OF CONTENTS
• ABSTRACT--------------------------------------------- II
• TABLE OF CONTENS ------------------------------ IV
• LIST OF FIGURES----------------------------------- V
• LIST OF TABLES------------------------------------- VI
• 1. INTRODUCTION ------------------------------- 1
• 2. METHODS ---------------------------------------- 3
• 3. RESULTS ------------------------------------------ 8
• 4. DISCUSSION ------------------------------------- 18
• 5. CONCLUSION------------------------------------ 22
• 6. REFERENCES ----------------------------------- 23
• 7. 국문요약 ------------------------------------------ 27
• LIST OF FIGURES
• Fig. 1 Surgical procedure for Roux-en-Y reconstruction included (A) division of the proximal jejunum and mesentery, (B) insertion of a 21-mm anvil into the resected distal jejunum, (C) insertion of the stapler body into the resected proximal jejunum, (D) anastomosis of jejunojejunostomy using a 21-mm circular stapler, (E) insertion of a 29-mm anvil into the proximal jejunum, and (F) anastomosis of the gastrojejunostomy by the Tonado method with a 29-mm circular stapler.
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• Fig. 2 Histological findings of biopsied tissues in the remnant stomach. (A) The tissue was given a score of 0 on evaluation, as per the grading system suggested by Dixon et al. (B) The tissue was given a score of 12.
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• Fig. 3 Study design according to the CONSORT diagram
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• Fig.4 EORTC QLQ – STO22 questionnaire
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• LIST OF TABLES
• Table 1 Demographic and clinical characteristics of patients who received the allocated intervention ---------------------------------------------------------- 10
• Table 2 Surgical outcomes for patients who received the allocated intervention
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• Table 3 Change in quality of life of the patients who were followed up 6 months postoperatively using EORTC questionnaires -------------------------------14
• Table 4 the RGB score classification -----------------------------------------15
• Table 5 Gastroscopic findings for patients who were followed up 6 months postoperatively using the RGB score-------------------------------------------16
• Table 6 Histological findings for the remnant stomach in patients in patients who were followed up 6 months postoperatively using the scoring system suggested by Dixon et al------------------------------------------------------------------------- 17