An Analysis Of Surgical Effects,Residual Stomach And Esophagus Mucosa Inflammation Using Totally Laparoscopic Distal Gastrectomy Via Different Digestive Tract Reconstruction Modes

Objective:To analyze the surgical effects,residual stomach and esophagus mucosa inflammation using totally laparoscopic distal gastrectomy via Delta-shaped anastomosis,Billroth Ⅱ anastomosis plus Braun anastomosis and Roux-en-Y anastomosis.Methods:90 patients of undergoing totally laparoscopic distal gastrectomy from April 2016 to April 2018 in our hospital were selected.According to different digestive tract reconstruction modes,patients were assigned to Delta-shaped anastomosis group,Braun’s anastomosis group(Billroth Ⅱ anastomosis+Braun’s anastomosis)and Roux-en-Y anastomosis group,30 cases in each group.Operation conditions,postoperative recovery,life quality,hospitalization time and costs,short-term complications,inflammatory factors and immune function were observed.Patients were followed by three years.After 6m and 1y of surgery,effects of different anastomosis modes on esophagus and residual stomach mucosa inflammation were examined by gastroscopy and pathology.Results:Intraoperative bleeding volume,initial anal exhaust time,postoperative extubation time,enteral nutrition time,postoperative feeding time,hospitalization time and costs among three groups showed no statistically significant difference(P>0.05);operation time in Delta-shaped group was shorter than that of other two groups,with statistically significant difference(P<0.05);operation time between Braun’s anastomosis group and Roux-en-Y anastomosis group showed no statistically significant difference(P>0.05);before surgery,Chew-wun Wu and ADL(activity of daily living)scores,showed no statistically significant difference(P>0.05);intraoperative bleeding volume among groups showed no statistically significant difference(P>0.05);initial anal exhaust time,postoperative extubation time,enteral nutrition time,postoperative feeding time and ambulant time among three groups showed no statistically significant difference(P>0.05);before surgery,Chew-wun Wu and ADL(activity of daily living)scores,CRP(C-reactive protein),WBC(white blood count),CD3+,CD4+,CD8+and CD4+/CD8+levels among three groups showed no statistically significant difference(P>0.05);after surgery,Chew-wun Wu and ADL scores,CD3+,CD4+and CD4+/CD8+levels in Roux-en-Y anastomosis group were higher than those of other two groups;CRP,WBC and CD8+levels were lower than those of other two groups(P<0.05);Chew-wun Wu and ADL scores,CD3+,CD4+and CD4+/CD8+levels between Delta-shaped anastomosis group and Braun’s anastomosis group showed no statistically significant difference(P>0.05);after 6m of surgery,reflux esophagitis rate in Roux-en-Y anastomosis group was lower than that of other two groups,with statistically significant difference(P<0.05);the occurrence of grade B and grade C reflux esophagitis among three groups showed no statistically significant difference(P>0.05);grade D reflux esophagitis was not occurred.The incidences of residual stomach inflammation in Roux-en-Y anastomosis group were lower than those of other two groups,with statistically significant difference(P<0.05);after 1y of surgery,reflux esophagitis rate in Roux-en-Y anastomosis group was lower than that of other two groups;the occurrences of grade A and grade B reflux esophagitis in Roux-en-Y anastomosis group were lower than those of Delta-shaped anastomosis;the difference was statistically significant(P<0.05);the occurrence of grade C reflux esophagitis among three groups showed no statistically significant difference(P>0.05);one case of grade D reflux esophagitis was occurred in Delta-shaped anastomosis group.The occurrences of residual stomach inflammation and ulcer in Roux-en-Y anastomosis group were lower than those of other two groups,with statistically significant difference(P<0.05);the incidence of gastric stump carcinoma among three groups showed no statistically significant difference(P>0.05).Conclusion:During totally laparoscopic distal gastrectomy,Delta-shaped anastomosis shortens the operation time and has fair effects with Billroth Ⅱ anastomosis plus Braun’s anastomosis.However,Roux-en-Y anastomosis can improve patient’s life quality,and reduce the short-term complications,occurrences of reflux esophagitis,residual stomach inflammation and ulcer,and inflammatory factors,produce less impact on the immune function and promote the fast recovery.It is worthy of clinical application and promotion.