Gastric Resection Different Digestive Tract Reconstruction Of VitaminB₁₂ Levels

objective：1.This clinical study pathological features of gastric cancerpatients with preoperative hematology indexes of research, looking for gastriccancer risk factors for postoperative lack of vitamin B12and provide theoreticalbasis or prevent the deficiency;2.Through the different ways of gastricresection on range and digestive tract reconstruction in patients withpostoperative levels’comparative study, explore its influence on this level,provide the basis for the choice of operation；And analyze three group of eachtime point after the level, looking for the postoperative change laws.Methods：This study selected in August in2012to February in2014,404hospital in mian yang，si chuan province.general surgery surgical treatment ofthe clinical data of98patients with gastric cancer, eliminate lost to follow upafter surgery and postoperative survival time less than1year, the remaining90patients were analyzed, and the study follow-up time ended in February2014.1. According to postoperatively whether lack of vitamin B12, the patientswere divided into group and not lack of group, the sex, age, the range of gastricresection, TNM staging and preoperative hematology indexes (this, folic acid,homocysteine level) and other clinical factors were analyzed, and then to thislack of clinical factors in patients with logistic regression analysis, looking forthis lack of risk factors.2.According to the scope of gastric resection and reconstruction, patientscan be divided into A, B, C three groups，Group A: proximal gastric resectionafter finish Ⅰ type reconstruction；Group B: total gastric resection after adjustable two-channel reconstruction；Group C: total gastrectomy Roux-en-Y after reconstruction. This level before and after operation in patients with three groups within the group and group, the comparison and analysis between differenttime points and observation of patients in each group of this level, this level ofchange rule analysis of each group patients.Results1.1Clinical factors of lack group and this was not the lack groupDemographic information: two groups of patients with no significantdifference in body mass index, ASA score, the proportion of male patients withthis lack of higher than female patients (P=0.004), and this lack of patient agealso larger (P=0.001).Preoperative and postoperative laboratory examination: this lack of groupof preoperative below this level of this lack of group (P=0.001), while the preo-perative Hcy levels higher than the lack of this group (P=0.006).Operationmode and stage: the proportion of the total gastric resection patientsexperienced this lack of a proximal gastric resection were higher (P <0.001), showing this lack of TNM staging and more late (P=0.002).1.2The lack of patients with single factor analysis results9index of single factor analysis showed: gender (P=0.032), preoperativeserum this level (P <0.001), preoperative serum Hcy levels (P=0.041), age (P<0.001), the scope of gastric resection (P <0.001) associated with this lack of(see chart4).1.3The lack of patient multiariable logistic regression analysis resultsStatistical significance was found in the single factor analysis of the fivevariables into the Logistic regression analysis, including gender, age,preoperative serum Hcy gastric resection range and this level as independentvariable, this level as the dependent variable (not lack=0, lack=1), themulti-factor Logistic regression analysis. Multiple factors analysis thatpreoperative serum level of this (OR=3.653,95%CI=2.259-5.907), age (OR =1.058,95%CI=1.041-1.091), gastric resection range (OR=11.668,95%CI=5.471-28.954) is a risk factor for this lack.2different surgical procedurebefore and after surgery in patients with vitamin B12level analysis.2.1A group of30patients, including2patients appeared this lack, rate of6.7%, after12months average was577.8±130.1pg/ml; Group B,29patientswith five patients appeared this lack, rate of17.2%, after12months of postop-erative average was468.6±177.5pg/ml; Group C in31patients, including7Patients appeared this lack, rate of22.6%, after12months ofpostoperative average was427.2±174.4pg/ml. Group A and group B vitaminB12Level of postoperation comparative difference was statistically significant(q=6.45, P=0.023).Group B and group C vitamin B12Level of postoperationcomparative difference was statistically significant (q=3.75, P=0.315).GroupA and group C vitamin B12Level of postoperation comparative difference wasstatistically significant (q=9.17, P=0.013).2.2A group of patients with postoperative1month,2months after opera-tion, postoperative march, June, September after operation, postoperativepostoperative peripheral venous blood levels of this December were592.4±189.5pg/ml，578.6±104.3pg/ml，608.7±127.4pg/ml，602.5±109pg/ml，597.2±127pg/ml，610.9±126.1pg/ml; Group B patients postoperative1month,2months after operation, postoperative march, June, September after operation,postoperative peripheral venous blood in December after this level were573.2±196.5pg/ml，512.9±189.2pg/ml，473.1±145.7pg/ml，436.6±186.0pg/ml，417.4±178.1pg/ml，398.7±169.6pg/ml；Group C after1month,2months afteroperation, postoperative march, June, September after operation, postoperativeperipheral venous blood in December after this level of6respectively568.6±194.1pg/ml，481.3±165.8pg/ml，420.1±189.2pg/ml，398.4±176.5pg/ml，368.3±158.3pg/ml，326.7±162.4pg/ml；A year after A, B, C are in different levels ofthe three groups of patients this level is reduced, two months after surgery to re -duce the group A, the most obvious are lower than the preoperative, differencereached statistical significance, postoperative march level is stable. Three mont-hs after surgery to reduce the most obvious group C, are lower than the preop-erative, difference reached statistical significance, then decreased slightly decr-eased. Postoperative change tendency is the same as C，B group werecompared with preoperative declined obviously, compared statisticallysignificant between two groups, but group B after this decline is small group C,and each time this level were higher than in group C. Postoperative this highestlevel in group A and group B, group C, the lowest among three groups andcomparing two trends were statistically significant (P <0.001), the level of eachpoint this time of group A was higher than other two groups, difference reachedstatistical significance.Conclusion1.Lack of group and this is not the lack of clinical factors comparison:male, total gastric resection of gastric cancer patients after surgery, this lack ofhigher percentage, this lack of older patients, preoperative this level is low, highHcy levels, preoperative TNM staging later.2.the multi-factor logisticregression analysis that preoperative serum vitamin B12level, age, gastricresection range is a risk factor for vitamin B12deficiency, in these risk factors,shall be carried out in a row this routine surveillance. Therefore, the risk factorsof these high-risk patients to give attention, for regular monitoring of the levelof this as soon as possible, to man-made factors give appropriate intervention,regulation of postoperative added this appropriately.3.in the aspects of gastricresection range: this level after total gastrectomy is lower after proximalgastrectomy, falling speed, this lack of proportion is larger; At the time ofreconstruction of digestive tract, with the reconstruction of the duodenum, theless the rate of postoperative VitB12duodenal reconstruction way higher, fallingslowly, at the same time, the proportion of this lack of more small;4, all this level postoperatively in patients with gastric cancer in general is on the decline,the proximal stomach resection group this level is only a drop in a short periodof time, in the early postoperative subsequently recovered gradually, level tendsto be stable. Total gastric resection group the decline speed, long duration, andit’s with full stomach resection, the duodenum reconstruction in patients withpostoperative VitB12levels while also hard to avoid is reduced, but the downspeed is more slow, the average is higher than patients without duodenalreconstruction; So under the condition of no violation of the principle ofoncology keep normal gastric tissue as much as possible, try to choose by thereconstruction of the duodenum.