Preliminary Study On The Clinical Efficacy Of Proximal Gastrectomy With Double Tract Reconstruction

Objective:To explore the primary clinical efficacy of proximal gastrectomy with double tract reconstruction,and to provide theoretical basis for the selection of an ideal approach for proximal gastrectomyMethods:A total of 57 patients with proximal gastric cancer admitted to the same treatment group in the second affiliated hospital of chongqing medical university from January 2016 to December 2018 were collected.All the patients were diagnosed by electronic gastroscopy pathological biopsy and total abdominal CT before surgery,and were able to undergo R0 resection.They did not receive neoadjuvant chemotherapy before surgery.Among them,there were 15 cases of gastroesophageal junction(Siewertll,type III),20 cases of gastric fundus carcinoma and 22 cases of upper 1/3 gastric carcinoma.According to different ways of resection range and digestive tract reconstruction was divided into three groups,Surgical procedures were classified as double tract reconstruction after proximal gastrectomy(PG-DT group)13 cases,esophagogastrostomy after proximal gastrectomy(PG-EG group)25 cases,Roux-en-Y esophagojejunostomy after total gastrectomy(TG-RY group)19 cases,observation of intraoperative situation,operation time,intraoperative blood loss,postoperative situation(first postoperative exhaust time,postoperative hospitalization days,early postoperative complications),Nutritional status(weight,hemoglobin,total protein,albumin ratio)and gastrointestinal discomfort(reflux,heartburn,stagnation,intestinal obstruction).Results:The operative time was 196.0±28.9min in the PG-EG group,which was shorter than 258.8±17.0min in the PG-DT group and 286.8±20.5min in the TG-RY group(p<0.001).The average intraoperative blood loss was 102.0±48.9ml in the PG-EG group,which was less than 142.3±53.4ml in the PG-DT group and 171.1±80.5ml in the TG-RY group(p=0.007).Postoperative exhaust time[(3.3±0.9)d,(3.1±1.0)d,(3.2±1.3)d,p=0.704)],postoperative hospitalization days[(12.1±1.7),(12.3±1.5),(12.4±1.5),p= 0.734]and postoperative early complications[7.6%(1/13),20.0%(5/25),10.6%(2/19),p=0.505]were not significantly different in PG-DT group,PG-EG group and TG-RY group(p=0.704).The weight loss ratio of the three groups was similar for half a year after surgery,The decrease ratio of hemoglobin,total protein and albumin in the PG-DT group and PG-EG,In the follow-up of half a year after the operation,the PG-EG group was more likely to have reflux,heartburn and stuck sensation than the PG-EG group and TG-RY group[reflux:40.0%(10/25),7.7%(1/13)and 10.5%(2/19),p=0.023;heartburn:32.0%(8/25),7.7%(1/13)and 5.3%(1/19),p=0.039;stuck sensation:44.0%(11/25),15.4%(2/13)and 5.3%(1/19),p=0.009)],there were significant differences in reflux,heartburn and stuck sensation between the three groups(p<0.05).There was no significant difference in postoperative intestinal obstruction between the three groups(p>,0.05).Conclusion:Compared with TG-RY,PG-DT has better nutritional status.PG-DT was superior to PG-EG in the prevention of reflux esophagitis and anastomotic stenosis by proximal gastrectomy.PG-DT is a safe and effective method for postoperative gastrointestinal reconstruction.For patients with proximal gastric cancer,PG-DT is an ideal choice.