| Objective:To explore the influence of two different anastomoses on postoperative quality of life of patients after proximal gastrectomy with dual-channel anastomosis and traditional esophagogastric stump anastomosis,and to compare the advantages and disadvantages of the two kinds of anastomoses,so as to provide clinical reference for the exploration of the ideal way of reconstruction of digestive tract after proximal gastrectomy.Methods:From January 2015 to February 2019,patients who were definitely diagnosed as proximal gastric cancer and treated with proximal gastrectomy in the tumor surgery department of Chifeng City hospital were selected.The patients were divided into the experimental group(the double tract group,DT group)and the control group(the esophagogastrostomy group,EG group).To compare the basic data,perioperative indicators and postoperative complications of the two groups;to select 5 time points(before surgery and January,March,June,and December after operation)to compare the diet and nutritional indicators of the two groups;QLQ-C30 and QLQ-STO22 were used to compare postoperative quality of life of the two groups.Results:According to the enter criteria and exclusion criteria,64 eligible patients were included in this study,including 31 in DT group and 33 in EG group.Within one year of follow-up,there were no cases of tumor recurrence,metastasis or death.One case in DT group failed to complete follow-up due to family economic reasons,two cases in EG group failed to complete follow-up due to economic reasons and one case was excluded due to traffic accident trauma.Finally,60 patients were included in the study,30 in DT group and 30 in EG group.(1)Comparison of basic data: there was no significant difference between the two groups in general case data,preoperative diet,nutritional indicators and quality of life scores(P > 0.05).(2)Comparison of perioperative indexes: the operation time of DT group was longer than that of EG group(202.83±15.12 vs 168.16±13.38 min,t=9.403,P<0.000),There was no significant difference in the time of first eating(6.83±0.84vs6.93±1.01,t=-0.417,P=0.678),the time of hospitalization(13.17 ± 1.66 vs 13.37 ± 1.77 d,t =-0.451,P = 0.654),the amount of intraoperative hemorrhage of the two groups(117.33±26.25 vs 127.00±28.67 ml,t=-1.362,P=0.178),the number of intraoperative gastric lymph node dissection(39.83±6.97vs39.27±7.32,t=0.307,P=0.760).(3)Comparison of postoperative complications: the incidence of reflux esophagitis in DT group was significantly lower than that in EG group(6.7% vs 26.7%,χ 2 = 4.32,P = 0.038);incision infection(3.3% vs 3.3%,P= 1.000),anastomotic bleeding(0% vs 3.3%,P = 1.000),anastomotic leakage(0% vs 3.3%,P= 1.000),postoperative ileus(0% vs 0%,P = 1.000),and postoperative delayed gastric emptying(0% vs 3.3%,P = 1.000),anastomotic stenosis(0% vs 3.3%,P = 1.000)of the incidence of single complications and total perioperative complications(3.3% vs 16.7%,χ 2 =1.667,P = 0.197)showed no significant difference.(4)Dietary recovery and nutritional indicators: there was no statistical difference(P > 0.05)in January after operation;But the body mass index(BMI),hemoglobin(HGB),prealbumin(PAB),total protein(TP)and albumin(ALB)of dietary recovery and nutritional indicators in DT group were significantly better than those in EG group at the various time points in January,March,June,and December(P < 0.05).(5)Comparison of quality of life evaluation: there were significant differences in the overall health and nausea,pain,loss of appetite,vomiting,emotional function areas in QLQ-C30 and pain,dietary restriction,reflow and anxiety areas in QLQ-STO22 between the two groups(P < 0.05);The overall health status and emotional function,reflux,restricted diet,pain,anxiety,nausea and vomiting,and loss of appetite in the DT group were better than those in the EG group at various time points in January,March,June,and December(P <0.05);In addition,most of the patients in DT group had reached or even partially exceeded the preoperative level in December,while the patients in EG group were still lower than the preoperative level.Conclusion:Double channel anastomosis is safe and feasible in the radical operation of proximal gastric cancer.Compared with the traditional esophagogastrostomy,the operation time is relatively longer,but it does not increase the perioperative risk and complications.It has obvious anti reflux effect,and has the advantages of good postoperative diet and nutrition recovery,high quality of life.It is an ideal digestive tract reconstruction after proximal gastrectomy for clinical promotion. |
PDF Full Text Request