| Objectives: 1.To investigate whether the reconstruction of gastrointestinal tract continuity by Billroth Ⅱ combined with Braun reduces postoperative bile reflux in gastric cancer,and to explore the effect of postoperative bile reflux on the prognosis of patients.2.comparative analysis with Billroth Ⅱ type Billroth Ⅱ combined with Braun reconstruction of gastrointestinal tract continuity of the operation duration,intraoperative bleeding,postoperative exhaust time,postoperative pull out the tube time,length of hospital stay,postoperative complications,and so on,analysis,whether to increase operation difficulty increase Braun anastomosis operation time,perioperative and postoperative complications,etc.3.The grade of postoperative anastomotic inflammation in gastric cancer by means of Billroth Ⅱ type Billroth Ⅱ combined with Braun were compared and recorded by means of endoscopic anastomotic mucosa sampling and pathological examination.To understand the significance of increasing Braun anastomosis to reduce anastomotic stenosis.4.To compare and analyze the postoperative life and health scores of the two methods of reconstruction of gastrointestinal tract continuity in gastric cance.Billroth Ⅱ type Billroth Ⅱ combined with Braun;To investigate whether increasing Braun anastomosis can improve postoperative quality of life.Methods: A retrospective analysis was Conducted on 65 cases of gastric cancer diagnosed pathologically by gastroscopy admitted to the Second People’s Hospital of Yunnan Province from January 2010 to December 2020.Among them,25 cases undenwent Billroth Ⅱ operation under laparoscopy or laparoscopy（observation group）,and 40 cases underwent Billroth Ⅱ combined with Braun operation under laparoscopy or laparoscopy（control group）.Gastric mucosa and anastomosis under endoscopy were compared between the two groups.The clinical symptoms of the two groups were followed up for six months to one year after operation.20 patients were randomlyselected for gastric juice test,and the equivalent values of total bilirubin,direct bilirubin,indirect bilirubin and bile acid were compared.SPSS 26.0 software was used to compare the gastric mucosa and anastomosis of the two groups under endoscopic review.The complications of the two groups were followed up from 3 months to 12 months after operation.Clinical symptoms were followed up for 1 year.Twenty patients were randomly selected from the two groups to take gastric juice test and compare the equivalence of total bilirubin,direct bilirubin,indirect bilirubin and bile acid.Statistical analysis was performed using X and independent sample T tests.Results: 1.The observation group was classified and compared under endoscopy,mainly comparing the incidence of gastric retention,anastomostomitis,reflux esophagitis,residual gastritis,bile reflux,bile attachment,place ulcer and anastomotic eminence.The incidence of residualgastritis and bile reflux in the observation group was significantly lower than that in the control group（P <0.05）.2.Endoscopic anastomosis was sampled for pathological examination.Chronic inflammation was observed in both the observation group and the control Group.Large,in this group compared with intestinal metaplasia and atrophy of the population accounted for a small proportion.There was no significant difference in anastomotic pathology grade between the two groups（P <0.05）.3.The clinical symptoms of the two groups were compared during the follow-up within 1 year.The symptoms mainly included abdominal pain,abdominal distension,fatigue,acid reflux,burning sensation,nausea,vomiting,and bile in vomit,etc.which occurred to varying degrees in both groups.Statistical analysis of data showed that there was no statistical difference in the incidence of clinical symptoms between the two groups（P >0.05）4.Respectively from two groups patients randomly selected 10 cases,the patient returned to the court review extract gastric juice do gastroscope composition analysis,composition containing total bilirubin,direct bilirubin,indirect bilirubin and bile acid,alkaline phospholipase,cholinesterase,mainly compare the total bilirubin,direct bilirubin,indirect bilirubin and bile acid,observation group total bilirubin concentration in gastric juice was significantly lower than control Group（P <0.05）;There was no significant difference in direct and indirect bilirubin concentrations between the two groups（P >0.05）.The concentration of total bile acid in observationgroup was significantly lower than that in control group（P <0.05）.5.There were no statistically significant differences in operation time,digestive tract reconstruction time,postoperative length of hospital stay,anastomotic bleeding,anastomotic impotence and intestinal obstruction between the two groups.compared with Billroth Ⅱ operation,Billroth Ⅱ combined with Braun operation reduced the occurrence of postoperative bile reflux for gastric cancer,with statistical significance（P <0.05）.Conclusion: The results of this study showed that there was no difference between the observation group and the control group in the operative time and postoperative short-term complications.It can be believed that the gastric cancer Billroth Ⅱ combined with Braun to reconstruct gastrointestinal continuity method does not significantly prolong the operative time,and can reduce the occurrence of postoperative long-term complications such as bile reflux and residual gastritis to a certain extent. |
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