Postoperative Complications And Quality Of Life Of Proximal Gastric Cancer In Two Types Of Reconstructions

ObjectiveThe purpose of this study is these two points:First,to observe the effects of two different reconstructions on total plasma protein,hemoglobin,prealbumin concentration and postoperative complications and their qualities of life in patients with Gastroesophageal junction cancer;Second,to discuss the reasonable operation mode of GJC,and provide scientific basis for the selection of reconstruction in proximal gastric cancer.Methods1.Choose 34 patients of Siewert?,?types of GJC from January 2015 to May 2017 in the second hospital affiliated to suzhou university of gastrointestinal surgery hospital,and use retrospectively analyzed,to retain the dual channel operation for gastric antrum(group A,14 cases)and classical total gastric resection Roux en-Y jejunum anastomosis of esophageal,20 cases(group B).Compare two groups of patients with perioperative operation time,intraoperative blood loss,postoperative anal exhaust time,eating liquid time,length of hospital stay and early postoperative complications,and long-term complications after surgery.Compare TP,HGB,PA concentration between the two groups with preoperative and postoperative 6 months and 12 months.Use the chew-wun Wu special symptom scale and the Spitzer life quality assessment table to assess the postoperative quality of life of two groups.The follow-up period was 6 to 18 months.We exclude Bormann?or existing distant metastasis or infringement cases of lower esophagus with preoperative CT,UGC and gastroscope.Preoperative TNM staging refer to Japanese standards specifications 14 th edition of TNM staging of gastric cancer treatment:0 case of IA period,2 cases of IB period,13 cases of?A period,9 cases of?B period,6cases of?A period,2 cases of?period,2cases of?C period,0 case of?period.2.Observation and follow-up observation included QOL indexes,mass indexes(TP,HGB,PA,Weight),common complication indexes(infection,bleeding,obstruction,reflux esophagitis,dumping syndrome,emptying,diarrhea)and so on.Postoperative specialist follow-up was conducted.The follow-up period was 6 to 18 months.3.SPSS 21.0 was used for statistical analysis.The counting data was tested by X~2,and t-test was used for measurement data.P<0.05 was considered statistically significant.ResultsAccording to the SPSS21.0 analysis,the results shows:1.During perioperative period,postoperative anal exhausting time,feeding time,operation time,intraoperative blood loss and hospitalization time between group A and group B were compared with P>0.05,which was not statistically significant.In terms of recent complications,such as wound infection and anastomotic leakage,the difference between group A and group B was not statistically significant(P>0.05).Of the long-term complications,group A has the lower probabilities of the reflux esophagitis and dumping syndromes than group B.It has statistical significance.There was no statistically significant difference between the two groups in abdominal distension,diarrhea and tumor recurrence because of P>0.05.2.There was no statistically significant difference between the two groups in preoperative TP,HGB and PA,as P>0.05.Also,there was no statistically significant in TP and HGB of postoperative 6 months and HGB of postoperative 12 months.But,there was statistically significant in PA of postoperative 6 months and TP and PA of postoperative 12 months.3.The Spitzer score was compared and analyzed of postoperative 6 months:the comparison between general activity and health indicator project of two constructions was statistically different between the two groups with P=0.02 and P=0.04.In chew-wun WU's special symptom score scale,the score trend changed due to different projects from time to time.The results shows:group A was significantly better than group B in terms of feeding time,diet and vomiting as the QOL of postoperative 6 months with statistically difference of P<0.05;group A was significantly better than group B in terms of weight recovery,distension and vomiting after meal as the QOL of postoperative 12 months with statistically difference of P<0.05.Conclusion1.There was no significant difference in the incidence of intraoperative time,intraoperative bleeding,time of intake,duration of hospitalization,and early postoperative complications between the two-channel operation of preserved gastric antrum group and total gastrectomy roux-en-y jejunostomy group.The incidence of reflux esophagitis and dumping syndrome of the two-channel operation of preserved gastric antrum group was significantly lower than that of the total gastrectomy roux-en-y jejunostomy group.The gastroscope and Barium meal showed that most barium went into the jejunum and a small number of barium went by residual stomach duodenum into jejunum after 30~60min delayed.No barium flowed back into the esophagus.2.The two-channel operation of preserved gastric antrum group was significantly better than the total gastrectomy roux-en-y jejunostomy group in PA and QOL of the same time after the operation.3.The two-channel operation of preserved gastric antrum was safe and feasible in GJC radical reconstruction with a reasonable removal scope and a relatively simple operation.It retained the gastroduodenal paths,and increased the effect of residual stomach storage bag.And eating with the macro-control dual channel path,can effectively reduce epigastric fullness and reflux esophagitis.The QOL of the two-channel operation of preserved gastric antrum was significantly better than the total gastrectomy roux-en-y jejunostomy.It was an ideal way of reconstruction of Siewert?type,SiewerIII type of radical proximal gastrectomy with the clinical value.