Comparative Study On Postoperative Gastrointestinal Drainage Of Patients Accepted Different Ways Of Esophageal Cancer Radical Surgery

Objective: 113 patients with esophageal cancer resection were enrolled in this retrospective study.To explore the gastric juice formation and drainage characteristics of different ways of gastric esophagus and the factors that affecting the postoperative gastrointestinal drainage of patients by comparing the postoperative gastrointestinal decompression drainage within 3 days of patients accepted different methods of esophageal cancer radical surgery.Methods:1 A total number of 113 patients who underwent esophagectomy by the sole surgical group of the Fourth Hospital of Hebei Medical University from September 2014 to December 2015 were enrolled in this retrospective study.We observed the volume of gastric juice of patients underwent different ways of esophageal cancer radical surgery within three days.2 These patients were divided into two groups: group TS(tubular stomach)and group NTS(non-tubular stomach).There were 58 patients in group TS which contained 39 men and 19 women,whose age ranging from 51 to 72.The median age of group TS was 63(63.05±4.52).19 patients in group TS were right thoracotomy and laparotomy,21 patients in group TS were right thoracotomy followed by laparotomy and left cervical anastomosis,18 patients in group TS were right thoracotomy followed by laparotomy and right cervical anastomosis,There were 55 patients in group NTS which contained 42 men and 11 women,whose ages ranging from 44 to 73.The median age of the group NTS was 63(63.14±6.43).The patients in group NTS followed open esophagectomy,10 patients in group TS were operation of esophageal resection by left thoracotomy and esophageal gastric anastomosis below aortic arch,45 patients in group TS were operation of esophageal resection by left thoracotomy and esophageal gastric anastomosis above aortic arch.3 Comparison of postoperative gastrointestinal decompression and drainage: All patients were placed gastrointestinal decompression tube in their residual stomach during the operation and were used acid suppression medicine postoperation.The gastrointestinal function of all patients were not restored in the previous three days postoperation.The gastrointestinal decompression and drainage volume of the first day,the second day and the third day after operation were recorded respectively,and the total amount was calculated.To find the factors influencing the diastolic and drainage capacity of gastrointestinal decompression and compare the difference of gastrointestinal decompression and drainage between patients underwent different surgical approaches,and discuss the gastric juice formation and drainage characteristics of different ways of gastric esophagus.4 Statistical method: All of the data collected were analyzed by SPSS13.0 statistical software.The postoperative gastrointestinal decompression volume of patients were expressed as mean±standard deviation(X±S).For the measurement data conformed to normal distribution and homogeneity variance,the single factor variance analysis(one way ANOVA)was used.The Wilcoxon rank sum test was applied to the two independent samples when the measurement data did not conform to normal and variance,and chi-square test for count data.P<0.05 was considered for significant differences(α=0.05).Results:1 The average gastrointestinal decompression volume was 54±50.85 ml in the first three days after surgery of the tubular group,while the mean gastrointestinal decompression was 120±61.66 ml of the non-tubular group(Z =-5.215,P <0.001).The gastrointestinal decompression of the tubular group was less than that of the non-tubular group;2 There was significant difference in postoperative gastrointestinal decompression between the tubular group(x~2 = 6.400,P<0.05).There was no significant difference in postoperative gastrointestinal decompression between the non-tubular group(P = 5.742,P> 0.05);3 There were no significant differences in gastrointestinal decompression volume between patients with different genders(Z=-0.433,P=0.665),ages(x~2=1.42,P=0.887),whether they smoked or not(Z=-0.01,P=0.992),whether they drinked or not(Z=-0.958,P=0.338),at different times after surgery(Z=-1.277,P=0.201).There were no significant differences There were statistically significant differences in gastrointestinal decompression volume between patients when their anastomosis position were different(Z=-2.209,P=0.027).Conclusion:1 Both the gastrointestinal decompression volume and the incidence of gastroesophageal reflux and the incidence of chest and stomach syndrome can be reduced in patients with Tubular esophagectomy(including McKeowen neck anastomosis and Ivor Lewis surgery).2 The higher the location of the anastomosis,the smaller the postoperative gastrointestinal decompression,when the tubular esophageal esophagus were used.3 The gastrointestinal decompression volume of patients was unrelated with their genders,ages,postoperative time,whether they smoked or drinked or not.