| Objective To study the feasibility of transecting cardia in modified Sugiura’s procedure,and compare the treatment outcome between transecting cardia and transecting loweresophagus, and study the influence of serum Gastrin, Motilin levels in these two differentprocedure.Method49patients who got therapies because of hemorrhage of esophageal varices withportal hypertension were divided into two groups, cardiac group(25cases) and esophagealgroup(24cases), with the method of Pocock＆Simon minimization, in our departmentfrom2012-07to2013-07. All of the patients in these two groups received the same surgeryprocedures those were formed with splenectomy and amputation of blood vessels aroundcardia, moreover, patients in cardiac group received cardiac transecting and anastomoseswhile patients in esophageal group received lower esophageal transecting and anastomoses.All of the serum samples of peripheral venous blood were collected on the every morningof the fixed time in peroperative period, and measured with ELISA (enzyme linkedimmunosorbent assay). The change of clinical index and the serum Gastrin, Motilin levels,and the clinical data include complication, change of esophageal varices, rehaemorrhagiarate, etc, were analyzed with comparative study.Result All of the patients’ procedures were successful with no serious complications, andthe operating time, amount of bleeding, anus exhausting time and length of stay afteroperation got no difference between cardiac group and esophagus group(P>0.05). Thepatients who felt dysphagia in esophageal group were more than cardiac group(2=10.889，P=0.001) at the7thday after operation, and still more at the13thday(Fisher exactprobability test P=0.037) even though the patients who felt dysphagia were fewer than the7thday. The patients who got a mass of hydrothorax or portal venous thrombosis had nosignificant difference between the two groups (P>0.05). No patients happenedperioperative death, refractory ascites, liver failure, hepatic encephalopathy, abdominalcavity infection, unexpected reoperation, anastomotic leak, esophageal and gastric leak and other serious complications.There were no significant differences in the change of leucocyte, platelet,amidotransferase, bilirubin and albumin between the two groups(P>0.05). The levels ofserum gastrin at the firstly postoperative day decreased significantly than preoperative(cardiac group F=63.529，P<0.001；esophageal group F=120.089，P<0.001), whilereturned to preoperative levels at the5th~7thpostoperative day, moreover, both of themexceed the preoperative levels at the7thpostoperative day (cardiac group F=78.411，P<0.001； esophageal group F=79.172， P<0.001), and stay at a higher level thanpreoperative. The change of the serum gastrin levels got no significant difference betweenthe two groups(P>0.05).The levels of serum motilin at the firstly postoperative day decreased significantlythan preoperative also (cardiac group F=177.538，P<0.001；esophageal group F=32.208,P<0.001), while returned to preoperative levels at the5th~7thpostoperative day. And itexceed the preoperative levels at the7thpostoperative day in cardiac group (F=53.332,P<0.001), and it was higher than esophageal group at the7th(F=7.016, P=0.011), whileesophageal group exceed the preoperative levels at the10thpostoperative day (F=10.442,P<0.001). The change of the serum motilin levels got no significant difference between thetwo groups(P>0.05).All of the patients got follow up at the6thmonth after procedure, and all of theesophageal varices took a favorable turn while rechecked gastroscopy, however,13caseswere found cardiac varices in esophageal group while none in cardiac group, the differenceheld statistical significance (2=16.987，P<0.001). In esophageal group, there were3caseswith dysphagia at the6thmonth after procedure, and4cases were found reflux esophagitiswith gastroscopy， and esophageal stenosis1case, gastric retention3case, andrehaemorrhagia1case because of cardiac varices rupture after4months from operation;while in cardiac group,1case with dysphagia，reflux esophagitis1case，gastric retention1case，and no cases was found esophageal stenosis or rehaemorrhagia, but no significantdifference between the two groups (P>0.05).Conclusion1. The cardiac varices were eradicated more thoroughly with fewer complication ofdysphagia, while gastric retention, gastric paralysis and other complications were not increased in patients who got the modified Sugiura’s procedure of transecting cardia thantransecting the lower esophagus.2. Although modified Sugiura’s procedure caused the damage of the vagus nerve,gastrointestinal dysfunction wouldn’t be serious, because of the increase of gastrin andmotilin levels with body’s self-regulation after procedure.3. There were no significant difference in the influences of serum gastrin and motilinlevels between transecting cardia and transecting the lower esophagus in modifiedSugiura’s procedure. |
