Observation Of The Effect Of Three Methods In The Reconstruction Of Digestive Tract During The Operation Of Esophageal Cancer

Objective:To explore the effect of improving the digestive tract by using modified tubular stomach esophagus reconstruction in thoracic esophageal cancer resection,and to find out the difference of different operation type.Method: 1.Retrospective survey was collected from January 2006 to March 2016,the Armed Police Corps Hospital of Anhui Province in 314 cases of thoracic esophageal cancer resection,including 257 males and 57 females,aged from 46 to 78 years old,with an average of 62.5 years old.2.To collect the gender,age,tumor location,whether the merger of severe cardiac and pulmonary dysfunction,anemia,nutritional status and other conditions,compared with preoperative general situation,the difference was statistically significant.3.The patients were divided into three groups according to the surgical reconstruction of digestive tract: the whole stomach esophagus operation group(A group,=102 n),contraction joint small bending group(B group,=104 n),cut the small group of the stomach(C group,n = 108).4.The operation time,intraoperative blood loss,postoperative 3 days thoracic closed drainage,postoperative hospital stay,preoperative and postoperative cardiac and pulmonary function indexes were observed in three groups.And the complications(anastomotic leakage,anastomotic stenosis,thoracic stomach syndrome,reflux esophagitis,residual fistula or gastric fistula)were observed and compared with the three groups of related data and statistical analysis.Result: 1 patients in each group compared to the preoperative general situation: age,tumor site differences were not statistically significant(P > 0.05).2 Three groups of patients with general surgery: the whole stomach esophagus replacement group(group A)and the contraction of small bending group(group B)and cut the small curvature of the stomach group(C group)compared with the small amount of bleeding(P<0.05),the operation time is shorter(P<0.05).But there was no significant difference between the three groups(P>0.05).3 Comparison of three groups before and after surgery on cardiopulmonary effects: three groups of patients with postoperative(MVV)maximal voluntary ventilation(TLC),total lung capacity(FEV1)and expiratory volume in one second was significantly lower than that before treatment(P<0.05).The indexes of cardiac and pulmonary function in A group were significantly lower than that in group B and group C(P<0.01),and the MVV and TLC indexes in group B were better than that in C group.4.Three comparison of postoperative complications of 3 groups of patients: all patients were successfully completed surgery,no perioperative death.Operation time was 2 ~ 4.8 h,average operation time(3 + 0.4)H.The postoperative complications of gastric esophagus were anastomotic fistula in 8 cases,anastomotic stenosis in 11 cases,thoracic stomach syndrome 29 cases,37 cases of esophagitis,anti flow gastric fistula;seam shrinkage gastric group anastomotic fistula in 7 cases,anastomotic stenosis in 14 cases,thoracic stomach syndrome in 15 cases,29 cases of esophagitis,anti flow gastric fistula;cutting the lesser curvature of the stomach in patients with anastomotic fistula in 2 cases,13 cases of anastomotic stenosis,4 cases of thoracic stomach syndrome,8 cases,1 cases of esophagitis flow stump fistula.Conclusion: 1.There was no significant difference in the incidence of anastomotic stricture,residual fistula or gastric fistula after operation between the threetypes of operation.2.The incidence of postoperative anastomotic leakage,thoracic stomach syndrome,and reflux esophagitis can be significantly reduced by replacing the esophagus with the tubular stomach instead of the whole stomach.3.Compared with the other two groups,the results showed that there was a significant difference in the reduction of the thoracic stomach syndrome,the other complication rate was no different from that of the whole stomach group.4.Tubular stomach esophagus in esophageal cancer surgery in the digestive tract reconstruction in relation to the other two kinds of surgery is the best,but there is still room for improvement in the details of the operation.