The Comparison Of The Anti-reflux Effect Of The Anterior Wall And Posterior Wall Of The Gastroesophageal Anastomosis In Radical Proximal Gastrectomy

Purpose In this study,different gastrointestinal reconstruction methods(esophago-anterior wall gastric anastomosis with anastomat and esophago-posterior wall gastric anastomosis with anastomat)were compared in patients with carcinoma of gastric cardia who executed proximal gastrectomy.To find out which anastomoses are more advantageous.To reduce the incidence of postoperative gastroesophageal reflux and complications to improve the patients' quality of life after operation.It can provide reference and guide for the future clinical application of these two anastomotic methods.Methods 60 patients of Gastrointestinal surgery department of Qinghai University Affiliated Hospital suffered carcinoma of gastric cardia were collected from October 2016 to October 2017.All the research object were divided into two groups according to the random grouping principle: The observation group(anterior group)and The control group(posterior group).Both of the group includes 30 cases.All patients received laparoscopic-assisted radical proximal gastrectomy.The anterior group was treated with esophago-anterior wall gastric anastomosis with anastomat and the posterior group was treated with esophago-posterior wall gastric anastomosis with anastomat.All the patients received telephone follow-up and in/out-patients review.During the period,the gastroesophageal reflux conditions of patients in the two groups were recorded in 3 months and 6 months after surgery(Using Visick classification and electron gastroscope reflux esophagitis classification)?Nutritional status?Gastrointestinal symptoms and Postoperative complications occurrence rate.The results are compared and analyzed.Statistical methods were used to collate and analyze all the data and got the conclusion.Results There has no significant difference between the anterior group and the posterior group in general situation,including gender composition(P=0.66),age distribution(P=0.49),degrees of pathological differentiation(P=0.60),The pathological tumor-node-metastasis stage(P=0.78),tumor size(P=0.57).There have no significant difference between the anterior group and the posterior group in intraoperative situation and postoperative complications,including operation time(P=0.12),Intraoperative blood loss(P=0.24),the number of lymph node dissection(P=0.14),Postoperative gastrointestinal function recovery time(P=0.60),The total length of hospital stay(P=0.43).There was no significant difference in the incidence of postoperative complications between the anterior group and the posterior group,including anastomotic hemorrhage(P=1.00),anastomotic leakage(P=0.55),intestinal obstruction(P=0.64),anastomotic stenosis(P=0.55).The visick classification showed that the esophageal reflux rate was lower in the anterior group than in the posterior group 3 months after operation,the difference was statistically significant(P<0.05)and the esophageal reflux rate was lower in the anterior group than in the posterior group 6 months after operation,the difference was statistically significant(P<0.05).The electron gastroscope reflux esophagitis classification showed that the esophageal reflux rate was lower in the anterior group than in the posterior group 3 months after operation,the difference was statistically significant(P<0.05)and the esophageal reflux rate was lower in the anterior group than in the posterior group 6 months after operation,the difference was statistically significant(P<0.05).There was no significant difference in preoperative nutrition index between the anterior group and the posterior group including blood nutrition index[Hemoglobin(P>0.05),Albumin(P>0.05)],Body Mass Index(P>0.05),Prognosis of nutrition index(P>0.05).The nutritional status of patients in the anterior group was better than that of the posterior group 6 months after operation including blood nutrition index[Hemoglobin(P<0.05),Albumin(P<0.05)],Body Mass Index(P<0.05),Prognosis of nutrition index(P<0.05).The GSRS score was lower in the anterior group than in the posterior group after operation(P<0.05),including 3 months after operation(anterior group: 6.7±1.5,posterior group:8.4±2.0),the difference was statistically significant(P<0.05)and 6 months after operation(anterior group:5.6±1.6,posterior group:7.3±1.4),the difference was statistically significant(P< 0.05).Conclusion The anti-reflux effect of esophago-anterior wall gastric anastomosis with anastomat was better than that of the traditional esophago-posterior wall gastric anastomosis with anastomat.There were no significant difference between the esophago-anterior wall gastric anastomosis with anastomat group and the traditional esophago-posterior wall gastric anastomosis with anastomat group in operation time,Intraoperative blood loss,the number of lymph node dissection,postoperative gastrointestinal function recovery time,the total length of hospital stay and postoperative complications.The postoperative nutritional status of esophago-anterior wall gastric anastomosis with anastomat was better than that of the traditional esophago-posterior wall gastric anastomosis with anastomat and the gastrointestinal symptoms was lighter than that of the traditional esophago-posterior wall gastric anastomosis with anastomat.