A Comparative Study Of Uncut Roux-en-Y And Traditional Roux-en-Y Anastomosis After Distal Gastrectomy For Gastric Cancer

Objective: Retrospective analysis of clinical datas of patients who underwent radical distal gastrectomy for gastric cancer with Uncut Roux-en-Y anastomosis or Roux-en-Y anastomosis,by comparing the perioperative and postoperative follow-up datas and clinical curative effects of the two groups,this study shall investigate the safety and efficacy of the Uncut Roux-en-Y anastomosis and provide references for choosing the digestive tract reconstruction method after distal gastrectomy.Methods: According to the standard of inclusion and exclusion,a total of 88 patients with distal gastrectomy for gastric cancer in Jiangsu Subei People’s Hospital from January 2014 to-2016 in September were selected as the subjects of the study.Among them,34 cases were treated with Uncut Roux-en-Y anastomosis,and the other group was Roux-en-Y anastomosis(n =54),grouped according to digestive tract reconstruction.The datas of the two groups were compared and analyzed,including general and pathological datas,intraoperative and postoperative recovery datas,nutritional status 6 months after operation,postoperative complications and follow-up results,the Uncut point recanalization of Uncut Roux-en-Y anastomosis group.SPSS17.0 software was used for statistical analysis,the measurement data were expressed as the x ±S,the two groups were compared with T test,and the count data were tested by X2.P<0.05 was found to be statistically significant.Results: There were 34 patients in the group of Uncut Roux-en-Y anastomosis,and the Roux-en-Y group had 54 cases.There was no statistical difference between the two groups in general clinical datas.There were 50 cases in stage I,31 cases stage II and 7 cases in stage III,and there were no significant differences between the two groups in pathological datas.There was no significant difference between the twogroups in operative methods,postoperative exhaust time,eating time and postoperative hospital stay.There were significant differences in the operation time,reconstruction time,bleeding volume,P=0.012,P=0.001,P=0.002 respectively.Respectively,the average operation time,reconstruction time and bleeding volume were 145±27 min、25.7±5.5min、67.9±23.5 ml in Uncut Roux-en-Y anastomosis group,and were lower than Roux-en-Y anastomosis group which were 160±27 min、30.2±6.1 min、100.9±57.9ml.6 months after operation,the weight loss,hemoglobin decline,the average value of albumin decreased was 0.9±4.0kg、-6.4±23.8 g/L、-1.4±6.8g/L in Uncut Roux-en-Y anastomosis group,while was 3.4±2.5kg、3.1±10.2 g/L、0.6±3.7g/L in Roux-en-Y anastomosis group,respectively.The Roux-en-Y group was significantly higher than the Uncut Roux-en-Y anastomosis group in the weight and hemoglobin decreased,P<0.001 and P=0.031.There was no statistical difference between the two groups in the reduction of albumin.The incidence of total complications in the two groups was 20.6% and 25.9% respectively,there was no significant difference in the incidence of complications during hospitalization.During the follow-up period,the incidence of complications in the two groups were 32.7% and 37.4%,respectively,there was no significant difference between the two groups in the incidence rate and the incidence rate of alkaline reflux gastritis.The incidence of RSS syndrome in Roux-en-Y group was significantly higher than that in Uncut Roux-en-Y group,P=0.048,the incidence of Roux-en-Y anastomosis group was 16.7%.However,the incidence of intestinal obstruction in Uncut Roux-en-Y group was significantly higher than that in Roux-en-Y group,P=0.027,there were 6 patients with postoperative intestinal obstruction in Uncut Roux-en-Y anastomosis group and the incidence rate was 17.6%.During the follow-up period,there were 4 cases of gastric stump cancer,1cases in Uncut Roux-en-Y anastomosis group and 3 cases in Roux-en-Y anastomosis group,all of them occurred in the postoperative period of about 1 years,all the patients were treated with surgery.2 cases died in the Roux-en-Y anastomosis group,and the age of the two patients was more than the age of 75 years.The recanalization rate of Uncut Roux-en-Y anastomosis groupwas 5.9%(n = 2),1 cases occurred in the postoperative period of 1 years,the other occurred in 18 months after operation,and then the alkaline reflux occurred.Conclusion: The clinical data of two groups were compared and analyzed,this study draws: 1.Compared with Roux-en-Y,choosing Uncut Roux-en-Y anastomosis can reduce the operation time,the time of digestive tract reconstruction,the amount of bleeding in the operation and improve the nutritional status of the patients;2.Compared with Roux-en-Y,choosing Uncut Roux-en-Y anastomosis reduced the incidence of RSS syndrome,but increased the incidence of postoperative intestinal obstruction,need to master the skills in dealing with the Uncut point,there may be closed Uncut Roux-en-Y recanalization after anastomosis;3.Uncut Roux-en-Y anastomosis can be selected in the reconstruction of digestive tract after distal gastrectomy,the safety and efficacy of this technique are comparable to the conventional Roux-en-Y,its short term efficacy is accurate and the long term efficacy needs further confirmation.