Clinical Comparative Study Of The Occurrence Of Gastroparesis After Radical Resection Of The Right Colon Using The Two Procedures (CME And D3)

Objective:By observing the occurrence of gastroparesis after radical right hemicolectomy using two different procedures(CME and D3),analyzing whether the differences existed between the two groups,further analyze the cause of postsurgical gastroparesis syndrome and provide reference for clinical work.Methods:A total of 133 patients undergoing radical right hemicolectomy for right colon cancer from September 2012 to September 2017 in Shanxi Provincial People's Hospital were selected,and preoperative combined diabetes,hypoalbuminemia,hypothyroidism,and postoperative patients with severe hypoproteinemia or poor blood glucose control were excluded.The remaining 109 patients were divided into the CME group and the D3 group according to the different method of radical right colon surgery.Comparing the two cases of gastroparesis after surgery,to determine whether there are differences between the two groups,and then to compare within the group and between the groups,further obtain postsurgical gastroparesis syndrome and what factors are associated.Results:The patients were divided into CME group and D3 group according to the difference in the way of taking the right hemicolectomy.The gastroparesis rate was 0.7%in the CME group and 76%in the D3 group.Statistical analysis showed that there was a statistically significant difference in the probability of gastric fistula between the two groups(?~2=19.205,P=0.000<0.05).After group comparison in each group,it was found that the occurrence of gastroparesis was not significantly related to preoperative intestinal obstruction,length of operation,and blood loss during surgery,but it was significantly related to postoperative abdominal infection and inflammatory syndrome.In the CME group,there was no statistical difference in the occurrence of gastric fistula with preoperative intestinal obstruction,length of operation,and blood loss during surgery(respectively:?~2=0.000,P=1.000;t=1.364,P=0.178;z=0.872,P=0.383),there was a statistically significant difference from inflammatory infection(?~2=16.933,P=0.000<0.05).In group D3,the occurrence of gastric fistula was not significantly different from preoperative intestinal obstruction,length of operation,and intraoperative blood loss(?~2=0.842,P=0.359;t=1.560,P=0.125;z=1.891,P=0.559),with statistically significant differences from inflammatory infections(?~2=20.233,P=0.000<0.05).After comparing the two groups of patients with no postoperative inflammatory infection,it was found that there was a statistically significant difference(?~2=10.311,P=0.001<0.05),and the risk of gastroparesis after D3 was higher.Conclusion:After radical right hemicolectomy,the incidence of postoperative gastric fistula was different in the CME group and the D3 group,which was significantly related to the range of surgery,postoperative abdominal infection,and inflammatory response syndrome.Therefore,right colon surgery should follow the principle of R0 resection,to avoid unnecessary surgery to expand the scope,accurate surgical operation,to avoid neurological plexus injury,and should actively control the postoperative inflammatory infection,reduce the risk of postoperative gastric fistula.