The Study On Function Of Tubular Stomach After Ivor Lewis Esophagectomy

There are a large number of patients with esophageal cancer in China.Esophageal cancer requires multidisciplinary treatment,however,surgery is the main treatment.Ivor Lewis esophagectomy has become one of the main surgical methods for esophageal cancer.Ivor Lewis esophagectomy adopts the thoracic and abdominal approachs.The tubular stomach is used to replace the esophagus that is resected.As the tubular stomach is more and more widely used in clinic,the advantages of the tubular stomach become more and more prominent.However,there are few reports on the study in function of tubular stomach.So far,enhanced recovery after surgery(ERAS)has been integrated into various clinical specialties.However,The measures and strategies of ERAS in esophageal cancer are still in the stage of exploration and perfection.The idea of "Non-tube no fasting" is the core content of ERAS in esophageal cancer.In order to provide more theoretical support and evidence-based medical evidences for "Non-tube no fasting" and promote the development of ERAS in esophageal cancer,we designed and carried out three studies: a retrospective study on secretory function of tubular stomach after Ivor Lewis esophagectomy,a prospective study on function of tubular stomach after Ivor Lewis esophagectomy,a randomized controlled trial on the necessity of gastrointestinal decompression after Ivor Lewis esophagectomy.Aim at explore theregularity of recovery on function of tubular stomach after esophagectomy,so as to analyze and verify the necessity of gastrointestinal decompression after esophagectomy,and to explore the feasibility and safety of Non-tube and the measures and strategies of ERAS in esophageal cancer.1.A retrospective study on secretory function of tubular stomach after Ivor Lewis esophagectomyFrom July 2013 to September 2015,167 patients with esophageal cancer were selected,who underwent surgical treatment in the department of Thoracic and Cardiovascular Surgery,Nanjing Drum Tower Hospital.After screening,84 patients were included in the study.We retrospectively analyzed the secretory function of their tubular stomach after surgery.The amount of gastric juice drainage of 84 patients included in the study in the first seven days after operation were collected and analyzed by SPSS 18.0.The results showed that the amount of gastric juice drainage increased gradually in the first seven days after operation.There was significant difference in the amount of gastric juice drainage between the second day and the first day after operation(P < 0.001).The difference in the amount of gastric juice drainage between the fifth and fourth day after operation was also significant(P < 0.021).And there were no significant difference between the other adjacent two days.2.A prospective study on function of tubular stomach after Ivor Lewis esophagectomyAccording to the inclusion criteria and the exclusion criteria,30 patients with esophageal cancer who underwent surgical treatment in the department of Thoracic and Cardiovascular Surgery,Nanjing Drum Tower Hospital,were continuously included in the study from January 2017 to May 2017.Then 3 patients excluded according to exclusion criteria.Aprospective study of secretion and motor function of tubular stomach was carried out in these 27 patients.The amount of gastric juice drainage was recorded continuously in the first seven days after operation,and gastrointestinal series was performed on the second day after operation.The number of peristalsis of tubular stomach per minute was recorded,and emptying of tubular stomach was observed.SPSS 18.0 was used for statistical analysis.The results showed that there was significant difference in the amount of gastric juice drainage between the second day and the first day after operation(P < 0.001).And there were no significant difference between the other adjacent two days.On the second day after operation,the peristalsis of tubular stomach was observed in all patients.The frequency of peristalsis was 1 to 5(3.0 ±1.0)times per minute,95%CI: 2.6 to 3.4.The rate of emptying of tubular stomach decreased gradually after take contrast-medium orally,but the contrast-medium could pass through the pylorus smoothly into the intestine in all patients.3.A randomized controlled trial on the necessity of gastrointestinal decompression after Ivor Lewis esophagectomyAccording to the inclusion criteria and the exclusion criteria,30 patients with esophageal cancer who underwent surgical treatment in the department of Thoracic and Cardiovascular Surgery,Nanjing Drum Tower Hospital,were included in the trial from June 2017 to October 2017.They were randomly and equally assigned to experimental group or control group.There was no gastrointestinal decompression after operation in patients of experimental group.On the contrary,The patients of control group underwent gastrointestinal decompression after operation.There was no significant difference in age(P=1.000),sex(p=1.000),tumor location(P=0.732),Pathological type(P=1.000),pathological stage(P=0.507),and operation time(P=0.674)between the two groups.We prospectivelyanalyzed the incidences of anastomotic leakage,anastomotic bleeding,gastroesophageal reflux,and the times of first flatus and first bowel movement after operation in two groups.We observed and recorded the relevant data.SPSS 18.0 was used for statistical analysis.The results showed that there were no significant difference in the incidences of anastomotic leakage(P=1.000),anastomotic bleeding(P=1.000),gastroesophageal reflux(P=1.000)between two groups.And there were no significant difference in the times of first flatus(P=0.629)and first bowel movement(P=0.599)after operation between two groups,too.4.Conclusion(1)The secretory function of tubular stomach recovers from the second day after Ivor Lewis esophagectomy.(2)The motor function of tubular stomach recovers from the second day after Ivor Lewis esophagectomy.(3)Without gastrointestinal decompression after Ivor Lewis esophagectomy is safe and feasible.(4)Without gastric tube after Ivor Lewis esophagectomy is feasible,and it is more reasonable to remove gastric tube on the second day after operation.