| Objective:By comparing the difference of Siewert II/III adenocarcinoma of esophagogastric junction(AEG)placed single-tract with double-tracts reconstruction in proximal gastrectomy with jejunal interposition postoperative nutritional status(hemoglobin,plasma total protein and albumin),postoperative complications,postoperative reflux esophagitis and its degree,postoperative long term quality of life,to explore the ideal way of reconstruction of digestive tract,in order to provide reference and guidance for future clinical work,so as to better improve the living standard of patients after operation.Methods:According to the standard of entry group,selected 97 patients who were diagnosed with Siewert II/III AEG from February 2014 to August 2017 in Shanxi Provincial Cancer Hospital and underwent proximal gastrectomy with jejunal interposition,according to whether the operation was blocked the intestinal tube between jejunal stoma and jejunal stoma was divided into two groups:single tract reconstruction group(50)and double tracts reconstruction group(47).Compared two groups of patients preoperative and postoperative3 months,6 months nutritional status(hemoglobin,total protein and albumin);Operation time,intraoperative blood loss,postoperative hospitalization days;Postoperative complications(anastomotic complications,abdominal effusion,intestinal obstruction,postoperative hemorrhage);Six months after surgery,the subjective symptoms such as regurgitation,nausea and vomiting,heartburn,dysphagia,retrosternal discomfort;The incidence of reflux esophagitis and the degree of reflux were examined by gastroscopy for half a year after the operation.The data were analyzed using SPSS22.0 statistical software,quantitative data to mean±standard deviation(?x±s),comparison between groups using t test,qualitative comparison of data between groups with x~2 test.The results of the analysis were statistically significant with the difference of p<0.05.Results:General comparison of preoperative patients in the two groups of gender,age,TNM stage and other aspects of the differences were not statistically significant(p>0.05);comparison of surgery related conditions:the two groups in the operation time,intraoperative blood loss and postoperative hospitalization time difference length were not statistically significant(p>0.05);complications after the operation:single tract group the incidence of perioperative complications was 4%(2/50),double tracts group perioperative complication rate was 6.4%(3/47),the difference was not statistically significant(p>0.05);nutrition index comparison:two groups of patients before the difference was statistically significant difference(p>0.05),three monthly index after operation there was no statistically significant(p>0.05),but the nutritional index in the first half of the postoperative patients,three indicators of single tract group were higher than the double tracts group,the difference was statistically significant(p<0.05).Comparison of half life quality after operation:the two groups of patients with reflux,heartburn,nausea and vomiting,dysphagia,retrosternal discomfort and other subjective symptoms incidence had no significant difference(p>0.05);gastroscopy results:both in reflux esophagitis incidence,or the reflux degree the two group,the incidence and degree of almost the same,the difference was not statistically significant(p>0.05).Conclusion:Comparison of single tract reconstruction with double tracts reconstruction in proximal gastrectomy with jejunal interposition,there is no significant difference between the two methods in surgical safety and postoperative complications;And there was no significant difference in the incidence and degree of reflux esophagitis between the two groups;However in comparison with the postoperative nutritional level,the single tract reconstruction has a better effect on the patient’s long-term nutritional recovery than the double tracts reconstruction.Therefore,single tract reconstruction is ideal for patients with type II/III AEG undergoing proximal gastrectomy and jejunal interposition.. |
