The Study Of Digestive Reconstruction Procedures And Quality Of Life After Total Gastrectomy

Objective: To investigate the effects of different digestive reconstruction procedures after total gastrectomy on quality of life.Methods: Two hundred and sixty one cases of total gastrectomy were retrieved from the file of our hospital (The First Affiliated Hospital of Dalian Medical University) between 2002– 2007. Among them, 168 cases have follow-up successfully and 78 cases volunteered to participate this clinical study. According to the reconstruction procedure, they were divided into the following four groups: Roux-en-Y (Group A); Pauli no's (Group B); Moynihan (Group C); and Double tract (Group D). Then, the following studies were carried out:①Questionnaire follow-up to investigate the general postoperative condition;②Serum albumin level and blood lymphocyte count to calculate the prognosis nutrition index (PNI);③Upper gastrointestinal barium meal to examine the healing state of the anastomotic stoma and the barium refluxing in the lower esophagus;④Radioimmunoassay to determine the basal blood motilin and cholecystokinin levels. All the information for the four groups were analyzed and compared to evaluate the pros and cons of the four reconstruction procedures.Results:1. The operation time ranges from 210±56 min to 300±45 min, Group D (Double tract) has the longest average operation time: 300±45 min (P <0.05).2. All the means of prognosis nutrition index (PNI) for the four groups are > 45. Group D (Double tract) has the highest PNI : 61.92±1.28 (P <0.05).3. There are only 67.5% of patients of Roux-en-Y group showed good appetite, lower than Group B (Pauli no's, 94.1%) and Group C (Moynihan, 94.4%) (P = 0.024); 62.5% of patients of this group showed weight loss, higher than Group C(Moynihan, 22.2%) and Group D (Double tract, 0%) (P = 0.002); All the patients of Group C(Moynihan) appeared acid reflux of different extent, the percentage obviously higher than Group A (Roux-en-Y, 22.5%)Group B (Pauli no's, 47.10%) and Group D (Double tract, 0%) (P< 0.05); The single-meal food-intake is increased in 94.1% of patients of Group B (Pauli no's) while the other three groups have none(P = 0.000).4. In the four groups, more than 83%of patients with visick grade I and II and there is no significant difference among them (P> 0.05). There is no significant difference (P> 0.05) among the four groups for blood nutrition index (hemoglobin and serum albumin) too.5. There is no significant difference (P> 0.05) among the four groups for blood basal motilin level. The blood basal cholecystokinin (CCK) level of Group A (Roux-en-Y) and Group D (Double tract) are higher than the other two groups (P < 0.05). However, there is no significant difference between Group A and D and between Group B and C.6. The barium of Roux-en-Y and Paulino's groups showed single way flow into the jejunum, the barium in Moynihan and Double tract groups showed two-way flow into the jejunum. The enteric cavity of Pauli no's and Double tract groups was distended when the barium meal passes while he enteric cavity of Roux-en-Y and Moynihan groups was not distended markedly. There are 50% patients in Moynihan group appear barium reflux in standing and supine position, more than Roux-en-Y group10% (P=0.038); The barium meal reflux in Group B (Pauli no's) and Group D (Double tract) are respectively 5.9% and 33.3%, no significant difference between them and among other groups (P>0.05).Conclusion: The prognosis nutrition and basal blood CCK level are higher in patients with Double tract digestive tract reconstruction procedure after total gastrectomy. And the quality of life of this group is apparently better than the other three groups. The advantages of this procedure are already apparent although this group has the longest average operation time, fewer case numbers, and no obvious ascendancy in reduction of postoperative complications. On the other hand, patients received Roux-en-Y procedure sleep better although they have poorer appetite and more weight loss. In addition, patients received Pauli no's procedure have an increased single-meal food-intake and near half of patients have no postprandial abdominal distention. Finally fewer patients received Moynihan procedure have diarrhea but more serious acid reflux, postprandial abdominal distension, and barium reflux.