Clinical Investigation Of Gastrointestinal Obstruction After Gastric Cancer Operation

Objective:To summarize the influencing factors, preventive measures,diagnosis and treatment of Gastrointestinal obstruction after gastric cancer,we collected5702cases who were diagnosed with gastric cancers andunderwent operations within11years in which185cases with thecomplication of postoperative Gastrointestinal obstruction.Methods:5702individuals, who were admitted to the Fourth of HebeiMedical University for treatment of gastric cancer and received operationsfrom January1996to December2006were recruited for this study. Thefactors retrospectively analyzed include general characteristics of patients andthe relevant factors of postoperative Gastrointestinal obstruction. It involvedGender and age, anamnesis, surgical treatment of gastric cancer such asproperty, parts, digestive tract reconstructions, the application of theanti-adhesion agent, the pathological staging and so on. The diagnostic criteriafor Gastrointestinal obstruction includes clinical manifestations of Abdominalpain and distension,nausea and vomiting, defecate exhaust stoping, andconfirmed imaging tests or surgical exploration. Data base of the5,702individuals was set up, and185of them with the complication ofGastrointestinal obstruction were specially analyzed. These statistical analyseswere performed with a computer software program for MicrosoftWindows(SPSS,13.0), and statistical significance was set at P<0.05.Results:1The incidence of gastrointestinal obstruction was3.24%in this group.2The incidences of gastrointestinal obstruction in male and femalepatients were3.37%and2.79%.There was no significant difference betweenthem(χ2=1.041,P=0.308).3The incidences of gastrointestinal obstruction in the groups of≥60 and <60of patients' age were3.03%and3.46%, There was no significantdifference between them(χ2=0.836,P=0.361).4The incidences of gastrointestinal obstruction in the patients with orwithout cardiopulmonary disease were2.79%and3.30%, which was nosignificant difference(χ2=0.425, P=0.515).5The incidences of gastrointestinal obstruction in the gastric cancerwith-diabetes group was6.71%%, significantly higher than the non-diabeticgroup, which was3.15%. There was significant difference betweenthem(χ2=5.858,P=0.016).6The incidences of gastrointestinal obstruction in the groups with orwithout abdominal surgery history were3.40%and3.23%, which was nosignificant difference(χ2=0.029,P=0.865).7The incidences of gastrointestinal obstruction in the groups of totalgastrectomy, distal gastrectomy and proximal gastrectomy were6.27%,6.04%and2.03%, and there was significant difference between them (χ2=62.354, P=0.000).8The incidences of gastrointestinal obstruction in the visceral resectionand non-visceral resection groups were5.31%and3.11%, and there wassignificant difference between them(χ2=4.897, P=0.026).9The incidences of gastrointestinal obstruction between the handstitching group and the use of stapler group were3.49%and2.88%, and therewas significant difference between them(χ2=1.137,P=0.296).10The incidences of gastrointestinal obstruction between the groups withand without anti-blocking agent were2.93%and3.46%, and there was nosignificant difference between them(χ2=1.263,P=0.261).11In the relapse group, the rate of nausea and vomiting, exhaust defecatestoping,mass and incomplete obstruction were43.55%,46.77%,22.58%and85.48%, while the rate in the other group was60.98%,75.61%,3.25%and25.20%,and they were all significantly different.12In the recurrent group, the cases whose primary tumor was poorlydifferentiated accounted for70.97%, were significantly higher than the non-recurrence group which accounted for54.47%(χ2=4.674, P=0.031),andthe cases with stage III and IV tumors accounted for87.1%, were significantlyhigher than the non-recurrence group accounted for66.7%(χ2=8.836,P=0.003).13The gastrointestinal obstruction appeared1week to240months afteroperation,which an average of5months,the average time of non-recurrenceobstruction was9.09months, while tumor recurrence obstruction was23.49months.14Among all the cases,101cases with the nonoperative treatment werecured finally, six cases of death;64cases of patients received surgery, eight ofthem received pure adhesion loose solution technique,23of them receivedadhesion loose with bowel resection and decompression,13cases receivedresection and anastomosis,15routine received short circuit surgery,3ofcolostomy,1case with pylorus stent implantation, and1case was pureexploration,62cases were cured,1death, and1case Abandoning therapy.Conclusion: Gastrointestinal obstruction is one of the seriouscomplications after gastric cancer which is commonly seen in the field ofgastric surgery.1The incidence of gastrointestinal obstruction was3.24%in this group.2Gastrointestinal obstruction are not associated with sex, age andcardiopulmonary diseases.3The incidence of gastrointestinal obstruction in the gastric-cancer-with-diabetes group were significantly higher than the non-diabeticgroup.4The incidence of gastrointestinal obstruction in the groups withabdominal surgery history was higher than the other group.5The incidence of gastrointestinal obstruction in the groups of totalgastrectomy and distal gastrectomy were significantly higher than theproximal gastrectomy group.6The incidence of gastrointestinal obstruction in the visceral resectiongroup was significantly higher than the non-visceral resection group. 7The incidences of gastrointestinal obstruction in the hand-stitchinggroup was higher than the group of using stapler.8The incidences of gastrointestinal obstruction in the group with usinganti-blocking agent was lower than the other group.9In the relapse group, the rate of nausea and vomiting, exhaust defecatestoping were significantly lower than the non-relapse group, while the rate ofmass and incomplete obstruction were significantly higher than thenon-relapse group.10Adhesive intestinal obstruction is the most common, followed bytumor recurrence obstruction.11In the recurrent group, the cases whose primary tumor was poorlydifferentiated were significantly higher than the non-recurrence group, whilethe cases with stage III and IV tumors were significantly higher than thenon-recurrence group.12The gastrointestinal obstruction appeared1week to240months afteroperation,which an average of5months,the average time of non-recurrenceobstruction was9.09months, while tumor recurrence obstruction was23.49months.13The diagnosis of Gastrointestinal obstruction was based on symptoms,signs, and also required the use of auxiliary examination to confirm.Abdominal X-ray film is still one of the most commonly used clinical meansof auxiliary examination.CT was playing an important role in the diagnosingof gastrointestinal obstruction.