| Obejective To investigate the clinical efficacy and safety of two laparoscopic surgery methods:non interrupting Roux-en-Y(URY)and Billroth II plus Braun in preventing bile reflux after operation for distal gastric cancer.MethedsA prospective and random selection of 60 cases of gastric cancer diagnosed by laparoscopic surgery between May 2016 and September 2017 in the 4~thh general surgery department of the second hospital of Lanzhou university.These patients met the requirements of distal advanced gastric cancer and collected information about patients.Using URY as the surgical method of 30 subjects,as the experimental group of this study;Another 30 cases of the subjects'operation method using Billroth II plus Braun,as the study of the control group.During the operation,the tumor of both groups was completely resected,and all the surgical principles for the strict implementation of D2 radical surgery,also complies with the operation standard of laparoscopic gastric cancer surgery,scope of lymph node cleaning including 1 and 4 sb,5,6,7,8 a,9,11 p,12 a groups such as lymph nodes.In the experimental group,the tumor and surrounding lymph nodes were thoroughly treated and completely swept,and the reconstruction of the gastrointestinal tract was performed to keep the digestive tract smooth.Using the Treitz ligament as the marker,the silk thread with the appropriate length was measured,since then,25 cm was taken from the distal direction of the jejunum,lift this jejunum and perform stomach-jejunum anastomosis with the residual stomach.At 15cm from the input side of the anastomotic mouth of the gastrointestinal tract,25cm from the outlet side of the anastomotic stoma of the stomach,the side of the distal jejunum and proximal jejunum were anastomosed with the silk thread,which is Braun anastomosis.Finally,at the input end of the anastomotic stoma of the gastrointestinal tract,it was used to measure the distance of the gastric jejunum anastomosis 5cm with the silk thread,with a proprietary closed-only closure,close the cavity(A linear closure of the joint head is used).In the control group,the tumor and lymph nodes were first treated and cleaned thoroughly.The lateral anastomosis of the stomach-jejunum and jejunum-jejunostomy,namely Braun anastomosis,was the same as that of the experimental group.The key point was that the control group did not close the intestinal cavity at 5cm from the input end of the gastric jejunum anastomosis in the experimental group.Respectively on two groups of patients during the surgery using the total time(min),from complete tumor cut down to the end of the digestive tract reconstruction between the total time(min),the operation process of the total blood loss(min),the use of D2 gastric cancer effect a radical cure to clean out the number of lymph nodes,department to check out the number of positive lymph nodes were analyzed.The PH value of gastric juice in the gastrointestinal decompression tube was measured in two groups of patients,1 day before surgery,1,2,3 and 4 days after surgery.In the first month after the operation,LDQ scores were compared between the two groups and the two groups of patients underwent gastroscopy in March after surgery,and the scores were evaluated according to the results of kleba endoscopy.Then,the clinical effect of the two groups of patients on the prevention of bile reflux was compared with the objective indicators combined with the PH of gastric juice and the comparison of LDQ scores and the comparison of the scores of kleba endoscopy.ResultsThe operation time,digestive tract reconstruction time,blood loss,number of lymph node cleaning,number of positive lymph node metastasis of the two groups of patients with independent sample t-test t,P values were 1.119,0.258;2.177,0.738;0.936,0.368;0.040,0.969;0.063,0.951.The P value obtained was greater than 0.05,so there was no statistically significant difference between the two groups in the above comparison.Compared with the control group,the experimental group still used t test compared with the control group in the measurement of the PH value of gastric juice before surgery.The result was t=0.055,P=0.957,P>0.05,and the difference was not statistically significant.The PH value of the gastric juice in the two groups of patients after 4 days of continuous measurement was first measured by the sphericity test of Mauchly in statistics.Results was P=0.037,P<0.05,suggesting that for four consecutive days after two groups of patients between the respective four PH measurement are interrelated and are not independent,need to use repeated measurement data analysis of variance for data processing.The multivariate test was carried out,and P=0.025,P<0.05,and the difference between the two groups was statistically significant.The comparison of LDQ scores in the first month after surgery was compared between the two groups.There were 25 cases in the experimental group(0-4]points,and 5 cases(4-8]points,and 0 cases(8-10]points.In the control group,there were 5 cases(0-4]points,20 cases(4-8]points and 5 cases(8-10]points.In the statistical method,Fisher exact test was chosen,and P=0.043,P<0.05,there was a difference,and the difference was statistically significant.Postoperative 3 months for two groups of patients with endoscopic bile regurgitation grading comparison,in which the experimental group kleba endoscopic score,0 points of 23 cases,1 point of 7 cases,2 points of 0 cases,3 points of 0 cases.Compared with the control group and the experimental group,the 0 points of 3 cases,1 point of 7cases,2 points of 19 cases,and 3 points of 1 case.The statistical method used was Fisher's exact test,and P=0.018,P<0.05,there was a difference,and the difference was statistically significant.In two groups of patients in the comparison of basic data,including age,BMI,gender,tumor size,TNM staging,histological classification,etc.,after processing with statistical method,the P value is greater than 0.05,there was no statistically significant difference between the groups.ConclusionIn comparison of total laparoscopic URY and Billroth II plus Braun two types of the digestive tract reconstruction in gastric cancer prevention postoperative bile regurgitation in come to the conclusion that total laparoscopic URY can significantly lower bile regurgitation and is safe and feasible. |
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