The Clinical Application Of Uncut Roux-en-Y Gastrojejunostomy In Total Laparoscopic Distal Gastrectomy

Background:In recent 10 years,with the rapid development of science and technology and update of surgical instruments,the clinical application of total laparoscopic gastrectomy has made great development and popularization,but there is still no uniform way of the digestive tract reconstruction after total laparoscopic distal gastrectomy.At present,the main way of reconstruction includes Billroth Ⅰ anastomosis(Delta anastomosis),BillrothⅡ anastomosis and Roux-en-Y anastomosis.As mentioned above,they have their own obvious flaws.Uncut Roux-en-Y anastomosis is on the basis of Billroth Ⅱ and Braun anastomosis,to close and not cut the proximal jejunum.In recent years,there are few reports about Uncut Roux-en-Y anastomosis in total laparoscopic distal gastrectomy at home and abroad,and the number of cases is few.This study intends to investigate the safety and clinical effects of Uncut Roux-en-Y anastomosis in total laparoscopic distal gastrectomy for gastric cancer.Method:Select 52 patients of distal gastric cancer who were underwent surgery of total laparoscopic distal gastrectomy at Zhejiang University Affiliated Sir Run Run Shaw hospital between March-December 2016 as the research object.Statistics of the patient’s gender,age,body mass index,observe and record intraoperative and postoperative conditions,including the time of operation,the time of digestive tract reconstruction,intraoperative blood loss,transfered operation rate,postoperative exhaust time,time for liquid and semifluid,postoperative hospital stay,perioperative complications,and postoperative bile reflux rate,the reversal rate of blocking site.Thus to investigate the safety and clinical effects of Uncut Roux-en-Y anastomosis in total laparoscopic distal gastrectomy for gastric cancer.Result:All the patients were completed operations successfully,no case was transferred to open operation,total operation time and anastomosis time were(202.2 ± 36.4)and(49.1± 5.9)minutes,intraoperative blood loss was(79.2 ± 62.5)ml,number of harvested lymph nodes and number of positive lymph nodes were(27.3 ± 11.6)and(4.3 ± 7.2).The first time to exhaust was(2.7 ± 0.8)days,the first time for liquid diet and semifluid diet intake were(3.7 ± 0.8)days and(4.7 ± 0.8)days,postoperative hospital stay was(9.4± 4.2)days.No perioperative death was found,pulmonary infection occurred in 1 case,incision infection occurred in 1 case,venous thrombosis between muscles in lower limb occurred in 1 case,the 3 cases were cured by conservative treatment,;The patients were followed up 3 to 12 months,during the period,through gastroscopy and gastrointestinal angiography,the reversal of blocking site and bile reflux were not found;Also Roux-en-Y syndrome was not found.Conclusion:Uncut Roux-en-Y gastrojejunostomy reconstruction is safe and feasible in total laparoscopic distal gastrectomy for gastric cancer,the clinical curative effect is fine.