| Objective:By comparing the integration of a type II/III gastric esophagus adenocarcinoma(AEG) placed between the proximal gastric resection jejunum anastomosis with total gastric resection Roux-en-Y anastomosis operation safety, perioperative complications, postoperative reflux esophagitis, postoperative long-term differences in the quality of life, with fully explore the proximal gastric resection by jejunum gastric resection Roux en- Y match forward application value.Methods:Strictly according to include and exclude standards for October 2012 to October2012 in Shanxi Province tumor hospital diagnosed with type II/III the integration of a stomach esophagus carcinoma proximal gastric resection between jejunum anastomosis and total gastric resection Roux-en- Y anastomosis of patients according to the way in the digestive tract reconstruction were randomly divided into two groups:jejunum anastomosis of and between Roux en- Y anastomosis group.Compare two groups of patients in the operation time, postoperative hospital stay, postoperative bleeding, anastomotic fistula, abdominal cavity effusion, pleural effusion,perioperative complications, such as small intestinal obstruction, death;Six months after the subjective reflux symptoms such as reflux, swallowing pain, nausea,vomiting, heartburn, retrosternal pain and the incidence of symptoms such as cough,fibre gastroscopy reflux esophagitis rate and postoperative 3 months, 6 months hemoglobin, total protein and albumin;The overall situation and related indicators,after application of statistical analysis compare their differences.Results:Two groups of patients’ age, sex, tumor differentiation, TNM staging is no statistical difference(p > 0.05).Two groups of patients have not anastomotic fistula;No deaths;Chest, abdominal cavity effusion not infected.Total gastric resection group: there are incomplete small bowel obstruction, observed in 4 patients with conservative treatment to heal;1 patients postoperative abdominal bleeding occurred that night, and the other 1 case with postoperative intraperitoneal hemorrhage, 2 days after conservative treatment.Placed between the jejunum group: there are 2 patients appeared low incomplete small bowel obstruction, 1 cases recovered after conservative treatment;Another 1 case after surgery to heal.Total gastric resection group complications incidence is 10.7%(6/56);Placed between the jejunum group complications incidence is 4%(2/50);Two groups of surgical complication incidence of no statistical difference(p = 0.164).Two groups of patients in the operation time,intraoperative bleeding, postoperative hospital stay compared with no statistical difference(p > 0.05).Always think buy jejunum surgery because of intraoperative anastomotic with one more total gastric resection, the digestive tract reconstruction is difficult and long operation time;But after this study found that both the operation time is no statistical difference.Proximal gastric resection by jejunum is not because the operation difficulty is increased by the increasing intraoperative bleeding,prolonged postoperative hospitalization.Two groups of patients in the preoperative and postoperative 3 months nutrition index comparing is no statistical significance(p > 0.05), after 6 months of nutrition index comparison difference between the two was statistically significant(p < 0.05), group buy jejunum nutrition index between the total gastric resection group increased significantly.Two groups of patients after swallowing pain, chest pain, cough, etc, there was no statistically significant difference(p > 0.05, and in such aspects as reflux, heartburn and nausea and vomiting,the difference was statistically significant(all p < 0.05).Through the digestive tract gastroscopy: total gastric resection group 64.3%(36/56) in patients with reflux esophagitis, with moderately severe reflux esophagitis patients were 21.4%(6/56);Buy jejunum group) in patients with 28% between reflux esophagitis, without moderately severe reflux esophagitis patients.Combined with table 9, in the event of reflux esophagitis aspects, total gastric resection group compared with the place between jejunum group difference was statistically significant(p < 0.05);- in combination table 10, in the event of a severe reflux esophagitis aspect, the whole place between gastric resection group and jejunum group difference was statistically significant(p < 0.05).Combined with the subjective examination and the result of gastrointestinal gastroscopy, set between jejunum not only reduces the integration of a type II/III gastric esophagus adenocarcinoma patients postoperative reflux esophagitis happened;More reduced- severe reflux esophagitis.Discussion:Through the comparison between the proximal gastric resection buy with complete jejunum anastomosis of stomach excision anastomosis of no difference between the postoperative complications, operation safety;The incidence of reflux esophagitis after patients significantly decreased and to a lesser degree, better postoperative nutritional status.Integration of a type II/III gastric esophagus adenocarcinoma patients buy jejunum anastomosis between the proximal gastric resection can improve the long-term quality of life, is an ideal way of surgical anastomosis, has a wide prospect of clinical application. |
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