| Objective:To discuss the difference between two different ways of reconstructing the digestive tract during radical resection of distal gastric cancer,and to study the feasibility and safety of the Uncut Roux-en-Y anastomosis in the stomach jejunum.At the same time,it includes the comparison of the Uncut Roux-en-Y anastomosis in the stomach jejunum,and the advantages and disadvantages of various methods of the reconstruction of the digestive tract after the other main stream of distal radical gastrectomy.Objective to investigate the safety and feasibility of non interrupted gastric jejunal Roux-en-Y anastomosis in the reconstruction of digestive tract during distal gastrectomy.Methods:A total of 100 consecutive patients who underwent distal gastrectomy for gastric cancer with complete follow-up data between from July 2015 to July 2017 in department of general surgery at the Second Hospital of Shandong University in China were included in this study.And according to the digestive tract reconstruction method is divided into two groups.The clinical data of 60 patients who were divided into Uncut group(n= 60)and Billroth ? group(n= 40)were collected.Throughout the study period,the same group of surgeons mainly treated all patients and were responsible for all procedures,including the surgical techniques as well as the choice of surgical instruments.Observations:(1)Intraoperative conditions:operation time,digestive tract reconstruction time,intraoperative blood loss and the number of transit laparotomy.(2)Postoperative clinical indexes:time to initial anal exhaust,time to drink water,time to initial liquid diet intake,postoperative hospital stay,visual analogue scale scores on the first and third days after the operation,time to out-of-bed activity,time to initial defecation,time to abdominal drainage tube removal.Early complications during hospitalization.(3)Postoperative serum stress indexes:one month after operation,gastrointestinal barium meal examination(anastomotic stenosis,early dumping syndrome);gastroscopy 3 months after operation,whether anastomotic ulcer hyperplasia,recanalization or fistula occurred;Six months after Roux stasis syndrome,alkaline reflux gastritis,hypoglycemia syndrome;1 year after the weight loss ratio and plasma albumin situation.Follow-up time as of January 2018.Statistical analyses were performed with SPSS 22.0.Measurement data following a normal distribution are presented as mean ± SD and were analyzed by T-test.Count data were analyzed by ?2 test.A P-value<0.05 was considered statistically significant.Results:1.There was no significant difference in operative time,intraoperative blood loss and laparotomy between the Uncut and Bi ? patients(t =1.339,1.880,2 = 0.129,P>0.05)Group digestive tract reconstruction time,the difference was statistically significant(t =2.749,P<0.05).2.Uncut group and the completion of the second group of anus exhaust the first time,to restore drinking time,the first time eating semi-liquid diet,postoperative hospital stay and postoperative day 1,3 visual acuity scores the differences were statistically significant(T =3.191,4.104,1.997,3.453,2.973,2.323,P<0.05).There was no significant difference in the time of the first laxativeness,the drainage time of the peritoneal drainage tube and the time of the initial ambulation(t = 0.462,1.879,0.687,P>0.05).3.The two groups of patients in the hospital during the occurrence of complications,Uncut group,the total number of cases completed Bi ? were 14 cases,10 cases,the proportion of the two groups was:23.3%and 25.0%difference between the two groups of no data Statistical significance;Postoperative bleeding,gastric emptying,gastric ischemic necrosis and anastomotic fistula,rupture of duodenal stump,postoperative obstruction,knife-edge infection,cardiopulmonary complications,venous thrombosis of lower extremity,Urinary tract infection cases were no significant difference(?2 = 0.191,0.058,0.011,0.129,0.191,0.191,0.042,0.129,0.042,P>0.05).4.There was no significant difference between the two groups in the incidence of anastomotic stenosis when the patients underwent re-examination and follow-up 1 month after operation(?2= 0.191,P>0.05).Compared with control group,the incidence of early dumping syndrome of uncut group has the statistically significant difference(?2= 3.917,P<0.05).After 3 months of review of electronicgastrointestinal endoscopy,recanalization or fistula occlusion of two groups of patients compared.There was no significant difference between the two groups(?2 =0.039,P>0.05).There was anastomotic ulcer in Uncut group and Bi ? group And hyperplasia cases,the difference was statistically significant(?2= 5.483,P<0.05).Roux stasis syndrome(RSS)was not observed in the two groups after 6-month outpatient follow-up.The incidence of hypoglycemia syndrome and alkaline reflux gastritis in the Uncut group was significantly lower than that in the complete control group.The difference between the two groups was statistically significant(?2 =1.974,15.837,P<0.05).After 1 year after follow-up,the weight loss in Uncut group's patients was significantly lower than that in patients in control group.The plasma albumin in patients undergoing repeat examinations was significantly lower than that in patients in control group one week after operation,and the difference between the two groups was statistically significant(t = 8.875,25.300,P<0.05).Conclusion:In a complete laparoscopic radical gastrectomy for distal gastric cancer,non-interrupted gastrojejunostomy Roux-en-Y anastomoses play a relatively simple advantage to maintain intestinal continuity and surgery to reduce postoperative RSS and reflux gastritis and a series of Complications,however,improve the nutritional status of patients.At the same time,it can shorten the hospital stay,improve patient comfort,satisfaction and with good safety and effectiveness.In conclusion,it is worth to be promoted. |
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