| ObjectiveBy comparing the safety of operation,postoperative gastrointestinal symptoms,gastrointestinal motility recovery,postoperative complications,changes of nutritional indexes 3 weeks after laparoscopic assisted radical gastrectomy for distal gastric cancer,the effects of different digestive tract reconstruction methods on operative safety,postoperative gastrointestinal symptoms,gastrointestinal motility recovery,postoperative complications,and the changes of nutritional indexes 3 weeks after operation were compared.One year after operation,the results of gastroscopy were different.To discuss the advantages and disadvantages of digestive tract reconstruction after laparoscopic assisted radical gastrectomy for distal gastric cancer.MethodThe clinical data of 238 patients with middle and lower gastric cancer admitted to our hospital from January 2013 to March 2018 were collected and analyzed retrospectively.all patients underwent laparoscopic assisted distal gastric cancer radical resection,of which 60 cases underwent Billroth-Ⅱ type.93 cases were treated with Billroth-Ⅱ + Braun anastomosis and 85 cases with Roux-en-Y anastomosis.The operation time,postoperative exhaust time,postoperative intake and semi-fluid diet time,postoperative hospital stay,postoperative short-term complications and their management measures,postoperative digestive tract symptoms and nutritional indexes at 3 weeks after operation were analyzed in each group.The results of gastroscopy were compared with those of follow-upgastroscopy one year after operation.ResultThere were no significant differences in age distribution,sex ratio,BMI,preoperative nutritional index,postoperative pathological stage,incidence of hypertension and incidence of diabetes among Billroth-Ⅱ group,Billroth-Ⅱ +Braun group and Roux-en-Y group.(1)comparison of postoperative kisses among the three groups of patients.There were no significant differences in short-term complications such as anastomotic leakage,anastomotic bleeding,anastomotic stricture,duodenal stump fistula,abdominal infection,abdominal hemorrhage,gastric emptying disorder,postoperative pneumonia,input loop obstruction and chylous leakage(P > 0.05).(2)There was no significant difference in the number of discharged cases of fasting again,resetting gastric tube,resetting abdominal drainage tube and abdominal drainage tube after digestive tract symptoms or complications occurred in the three groups(P > 0.05).(3)The incidence of postoperative abdominal pain and abdominal distension in Billroth-Ⅱ group was significantly higher than that in the other two groups(P < 0.05),and the incidence of hiccup and heartburn in Roux-en-Y group was significantly higher than that in PCT group(P < 0.05).(4)There was no significant difference in the changes of short-term nutritional indexes such as BMI,albumin and lymphocyte count between the three groups at 3 weeks after operation(P > 0.05).(5)The operation time of Roux-en-Y group was significantly different from that of BⅡ group and Billroth-Ⅱ+Braun group(P < 0.05),but there was no significant difference between Billroth-Ⅱ group and Billroth-Ⅱ+Braun group(P > 0.05).(6)The postoperative intake time and semi-fluid diet time in Billroth-Ⅱ group were significantly longer than those in Billroth-Ⅱ+Braun group and Roux-en-Y group(P< 0.05).(7)The postoperative hospital stay in Billroth-Ⅱ group was significantly longer than that in Billroth-Ⅱ+Braun group and Roux-en-Y group(P <0.05).(8)The results of gastroscopy one year after operation showed that the bile reflux rates from high to low were BⅡ anastomosis(71.7%),BⅡb(45.2%)and RY(8.2%),respectively.there was significant difference between the three groups(P <0.05).The incidence of reflux gastritis from high to low was BⅡ anastomosis(56.7%),BⅡb(26.9%)and RY(7.1%).There was significant difference between the three groups(P < 0.05).The incidence of anastomotic inflammation from high to low was BⅡ anastomosis(70.0%),BⅡb(29.0%)and RY(14.1%).There was significant difference between the three groups(P < 0.05).The anastomosis of BⅡ(41.7%)was higher than that of BⅡb(10.8%)and RY(5.9%)in esophagitis(P <0.05).There was significant difference between),BⅡ and BⅡb and RY(P < 0.05).Conclusion(1)Compared with BⅡ,1BⅡ+Braun and Roux-en-Y have many advantages.we think they can be used as an ideal method for radical resection of distal gastric cancer.(2)Compared with Roux-en-Y,the operation time of BⅡ+Braun is longer than that of BⅡ+Braun,but its anti-bile reflux ability is stronger than that of BⅡ+Braun,.We think that Roux-en-Y should be used as far as possible when the operation time is ignored.Objective To compare the operative safety,postoperative gastrointestinal symptoms,gastrointestinal motility recovery,postoperative complications and postoperative complications between Roux-en-Y(RY)and Uncut Roux-en-Y(URY)anastomosis for distal gastric cancer by laparoscopy.The difference of short-term nutritional indexes after operation and the results of gastroscopy one year after operation,then to discuss the reasonable choice of above two digestive tract reconstruction methods for laparoscopic assisted radical gastrectomy for distal gastric cancer.Method The clinical data of 96 patients with middle and lower gastric cancer admitted to our hospital from January 2013 to March 2018 were analyzed retrospectively.all patients underwent laparoscopic assisted radical gastrectomy,including 55 cases of Roux-en-Y anastomosis.Uncut Roux-en-Y anastomosis was performed in 41 cases.The differences of operation time,postoperative exhaust time,postoperative fluid and semi-fluid diet time,postoperative hospital stay,postoperative short-term complications and management,postoperative digestive tract symptoms,and nutritional indexes at 3 weeks after operation were compared in each group.One year after operation,the results of gastroscopy were compared.Results(1)Postoperative anastomotic leakage,anastomotic bleeding,duodenal stump fistula,abdominal infection,abdominal bleeding,gastric emptying disorder,postoperative pneumonia,input loop obstruction,replacement of gastric tube,fasting after diet were compared between 1Roux-en-Y group and Uncut Roux-en-Y group.Reset.There was no significant difference in postoperative complications and management measures such as abdominal drainage tube and chylous leakage(P > 0.05).(2)The postoperative abdominal pain in Uncut Roux-en-Y group was higher than that in Roux-en-Y group(P < 0.05),and the difference was statistically significant.(3)The postoperative exhaust time and postoperative fluid diet time in Uncut Roux-en-Y group were significantly shorter than those in Roux-en-Y group(P < 0.05).(4)There was no significant difference in BMI,albumin and lymphocyte decrease between 4Uncut Roux-en-Y group and Roux-en-Y group at 3 weeks after operation.(5)one year after operation,gastroscopy showed that the rate of anastomotic bile reflux,the incidence of gastric retention,the incidence of residual gastritis,the incidence of anastomotic inflammation and the incidence of esophagitis in Roux-en-Y group were significantly higher than those in Uncut Roux-en-Y group(P > 0.05).There was no significant difference between the two groups.Conclusion Both Uncut Roux-en-Y and Roux-en-Y have good anti-reflux effect,but they do not suggest that one of them has obvious advantages and become the only selection criterion for distal gastrectomy.The specific operation should be determined by the surgeon’s habit and the patient’s own situation. |
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