| BackgroundGastric cancer(GC)is a kind of malignant tumor of digestive tract with very high morbidity and mortality,which poses a great threat to human life and health.In recent years,the incidence of upper gastric cancer has been increasing year by year in the overall incidence of gastric cancer,and its treatment has gradually attracted the attention of clinicians.Surgery is the main treatment for patients with upper stomach cancer.For patients with upper gastric cancer,total gastrectomy(TG)has become a common surgical method in clinical practice due to its thoroughness in tumor resection and lymph node dissection as well as good postoperative anti-reflux effect.However,inevitable postoperative nutritional metabolism disorders seriously affect patients’ postoperative quality of life,especially for early upper gastric cancer patients who are expected to have a good prognosis.In recent years,proximal gastrectomy(PG)has been used more and more in patients with upper gastric cancer because it can preserve part of the gastric function and improve the postoperative quality of life.The initial reconstruction of the digestive tract in PG is esophagogastric stump anastomosis,but postoperative reflux is common due to the removal of the cardia.Therefore,in order to solve this problem,experts have proposed a variety of different ways of digestive tract reconstruction,including double tract reconstruction,tubular gastroesophageal anastomosis and so on.In order to optimize the surgical treatment of patients with upper gastric cancer,it is of great clinical significance and research value to compare the clinical efficacy of different digestive tract reconstruction methods.ObjectiveThe clinical efficacy of three different digestive tract reconstruction methods after PG for patients with upper gastric cancer were compared to evaluate the advantages of various digestive tract reconstruction methods and provide theoretical basis for optimizing the surgical treatment of patients with upper gastric cancer.MethodsThe clinical data of 127 patients with upper gastric cancer admitted to the Department of Gastrointestinal Surgery of the People’s Hospital of Henan University from January 2017 to June 2020 were retrospectively analyzed.The patients were divided into 3 groups according to the different methods of digestive tract reconstruction after proximal gastrectomy,which were respectively esophagogastric anterior wall anastomosis group(EG group),double tract reconstruction group(DTR group)and tubular gastroesophageal anastomosis group(TGA group).The basic data,postoperative reflux situation,intraoperative situation,postoperative recovery situation,occurrence of postoperative complications and nutritional status of the three groups of patients were observed.SPSS 21.0 statistical software was used for data processing,and P < 0.05 was considered statistically significant.Results1.Basic data: There was no statistical significance in gender,age,body mass index(BMI),tumor size,postoperative TNM stage,tumor differentiation degree and tumor location among the three groups(P >0.05).2.Postoperative reflux situation:The incidence of reflux esophagitis(RE)in three groups one year after surgery was as follows: EG group(36.17%),DTR group(4.76%),TGA group(7.89%)(P < 0.05);Pairwise comparison among the three groups showed that the incidence of RE in DTR group and TGA group was much lower than that in EG group 1 year after surgery(P<0.05),while no significant difference was found between DTR group and TGA group(P>0.05).There were no significant differences in reflux diagnostic questionnaire(RDQ)scores among the three groups before surgery(P>0.05);RDQ scores were significantly different at 1 month,3 months,6 months,12 months and 24 months after surgery(P<0.05).Pairwise comparison among the three groups showed that RDQ scores in DTR group and TGA group were lower than those in EG group at 1 month,3 months,6 months,12 months and 24 months after surgery,and there were significant differences(P<0.05).There was no significant difference between DTR group and TGA group(P>0.05).The incidence of gastroesophageal reflux disease(GERD)was different among the three groups at 1month,3 months,6 months,12 months and 24 months after surgery(P<0.05).Pairwise comparison among the three groups showed that the incidence of GERD in DTR group and TGA group at 1 month,3 months,6months,12 months and 24 months after surgery was much lower than that in EG group(P<0.05),and no significant difference was found between DTR group and TGA group(P>0.05).3.Intraoperative situation:There were differences in operation time among the three groups(P<0.05).Pairwise comparison between the three groups showed that there were differences between any two groups,that is,the DTR group was longer than the TGA group and the TGA group was longer than the EG group(P<0.05).There was no significant difference in intraoperative blood loss(P>0.05).4.Postoperative recovery situation:There were no significant differences in the first postoperative exhaust,defecation,eating,time to get out of bed and postoperative hospital stay among the three groups(P >0.05).5.Postoperative complication:There were no significant differences in postoperative bleeding,anastomotic leakage,abdominal and pelvic infection and respiratory complications among the three groups(P>0.05).There were differences in postoperative anastomotic stenosis,delayed gastric emptying and total complications(P < 0.05).Pairings between the three groups showed that the incidence of postoperative anastomotic stenosis,delayed gastric emptying and total number of complications was significantly higher than that in DTR group,and the incidence of postoperative anastomotic stenosis in TGA group was higher than that in DTR group(P<0.05).Other than that,no significant difference was found in pairwise comparison among the three groups(P>0.05).6.Nutritional status:There were no significant differences in preoperative nutritional indexes(total protein,albumin and hemoglobin)among the three groups(P>0.05),but there were differences at 12 months after surgery(P<0.05).Pairwise comparison among the three groups showed that the nutritional indexes of DTR group and TGA group were better than those of EG group 12 months after operation(P<0.05).DTR group and TGA group were similar(P>0.05).In addition,the nutritional indexes of the three groups were significantly decreased 12 months after surgery compared with those before surgery(P<0.05).The body weight of the three groups before surgery and 1month and 3 months after surgery was basically the same(P>0.05),but the body weight of the three groups at 6months,12 months and 24 months after surgery was significantly different(P<0.05);Pairwise comparison among the three groups showed that the body weight of DTR group and TGA group was higher than that of EG group at 6months,12 months and 24 months after surgery(P<0.05).There was no significant difference between DTR group and TGA group(P>0.05).In addition,the body weight of the three groups at 1 month,3 months,6 months,12 months and 24 months after surgery was significantly decreased compared with that before surgery(P<0.05).ConclusionsCompared with EG,DTR and TGA have good surgical safety,postoperative anti-reflux effect and better postoperative nutritional status,and effectively improve the postoperative quality of life of patients. |
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