| Background and ObjectiveGastric cancer is a common malignant tumor in digestive system,respectively separated the second morbidity and the third mortality of malignant tumor in China.Radical surgery is probably the only way to cure this disease.Epidemiological statistics show that the overall incidence of gastric cancer worldwide is on the decline,but at the same time,including China,the proximal stomach cancer incidence of the disease is on the rise.For advanced proximal gastric cancer,radical total gastric resection have been supported by more and more clinical data than the proximal stomach cancer radical resection.Roux-en-Y reconstruction is commonly used method in the digestive tract reconstruction after total gastrectomy for easy operation,low postoperative anastomotic complications.But some patients appear on the chronic abdominal pain,abdominal distention,nausea,vomiting,without tumor recurrence and postoperative physical obstruction cases,and these series of symptoms are called Roux Stasis Syndrome(RSS).It becomes a more prominent factor affects patients’ postoperative quality of life.The abnormal transection of the small intestine caused by the separation of the integrated digestive tract has been thought the dominant reason for the RSS.Uncut Roux-en-Y anastomosis designed to reduce the occurrence of RSS,obtains the good curative effect in the distal stomach surgery,while is less applied in total gastric resection.To explore the application of uncut anastomosis in the radical total gastrectomy,we carry out this study.MethodsThe clinical data of 144 operation patients with radical total gastric resection for gastric cancer are Retrospectively analyzed.According to different digestive tract reconstruction methods,these patients are divided into uncut Roux-en-Y group and Roux-en-Y group.Analyzed the common clinical data to test the difference of the two group.Count and compare the operation time,the blood loss volume,the early and long-term postoperative complications incidence rates,the occurrence of the Roux Stasis Syndrome,the food intake quantity,the prognostic nutritional index(PNI)and the Visick points class situation.Results(1)There was no significant difference in the time of the operation time and the blood loss volume between the two groups(P>0.05).(2)There were no occurrence of the Duodenal stump fistula and perioperative mortality.There were no significant differences in the incidence of the early postoperative anastomosis complications between two groups(P>0.05).(3)The incidence rates of the dumping syndrome and the reflux esophagitis had no significant differences(P>0.05),while the Roux Stasis Syndrome occurrence rate in the uncut group was significantly less than the Roux group(P<0.05).(4)The Visick points class Ⅰ-Ⅱ and the food intake quantity reached the 80% of the preoperative level postoperative 12 months had significant differences(P<0.05),the uncut group both were significantly higher than the Roux group.(5)The Repeated Measures and the Multivariate Analysis showed that:(1)The PNI at the different time had significant differences(P<0.05).(2)The PNI among the two groups had no significant differences(P>0.05).(3)The PNI before the operative and the PNI after 6 months both had no significant differences(P>0.05),while the PNI after 12 months had significant differences(P<0.05),and the uncut group was higher than the Roux group.(4)The variation trends of the PNI were significant different(P<0.05).Conclusions1.The uncut Roux-en-Y anastomosis doesn’t add the operative risks and the occurrence rates of the early postoperative complications,and have the similar advantages of preventing the reflux Esophigitis.2.The uncut Roux-en-Y anastomosis has apparently advantages in the decrease of the Roux Stasis Syndrome.3.The uncut Roux-en-Y anastomosis can improve the postoperative food intake,the nutrition status and the life quality of the patients. |
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