| Objective: The common complication of advanced unresectable distal gastric cancer is outlet obstruction and tumor bleeding.The preferred treatment method is to remove the obstruction by bypass surgery,which improves the quality of life and prolongs the survival time.The traditional surgical method is gastrojejunostomy,but there are certain defects in this surgical method,and there are many postoperative complications.The modified Devine exclusion can make up for the deficiency of traditional gastric jejunum surgery,and can obviously improve the quality of life of patients.In this study,retrospective analysis was performed to compare the advantages and disadvantages of the modified Devine exclusion and gastric jejunostomy in the treatment of distal unresectable gastric cancer.Methods: According to the inclusion and exclusion criteria,The Northern Jiangsu People's hospitals were screened for the treatment of patients with distal unresectable gastric cancer using modified Devine exclusion and gastrojejunostomy from September 2012 to September 2019.A retrospective analysis was performed and 61 patients were included.There were 25 in the Devine open surgery group and 36 in the traditional gastrojejunostomy group.The general information,intraoperative data,postoperative recovery,postoperative complications,and patient satisfaction were analyzed and compared.Results: General information: There were no significant differences in gender,age,and BMI(BMI)between the two groups of patients(P> 0.05).Intraoperative data: The operation time was 119.2 ± 35.2(min)and 125.8 ± 37.8(min)in the two groups,with no significant difference(p> 0.05).The intraoperative blood loss was 46.4 ± 21.1(ml),64.2 ± 46.2(ml),no significant difference(p> 0.05).Intraoperative data: The operation time was 119.2 ± 35.2(min)and 125.8 ± 37.8(min)in the two groups,with no significant difference(p> 0.05).The intraoperative blood loss in the two groups was 46.4 ± 21.1(ml),64.2 ± 46.2(ml),no significant difference(p> 0.05).Postoperative recovery: postoperative anal exhaust time was 4.7 ± 1.1(d)and 5.4 ± 1.4(d)in the two groups,with no significant difference(p> 0.05),the time to resume eating in the two groups was 6.6 ± 2.5(D),7.6 ± 2.9(d),there is no significant difference(p> 0.05).There are no significant differences between the two surgical methods in terms of operation time,intraoperative blood loss,postoperative anal exhaust time,and diet recovery time.This shows that the modified Devine open surgery has no obvious advantages in terms of surgical trauma and postoperative intestinal function recovery compared with the gastrojejunostomy.In terms of the incidence of postoperative complications and survival time,the modified Devine open surgery has a significant advantage over gastrojejunostomy,and gastrojejunostomy is more prone to anastomotic stenosis.Therefore,the modified Devine exclusion is a safe and effective surgical method,and it is worth promoting in the treatment of unresectable distal gastric cancer.1 month after the operation,the increase of ALB in the two groups was 1.9±5.3(g/L)and 0.7±6.4(g/L),respectively,with no significant difference(p>0.05).In summary,there is no significant difference in postoperative recovery between the two groups.Postoperative complications: No tumor infection or reflux esophagitis occurred in the two groups during follow-up.The incidence of postoperative gastric emptying disorder in the two groups was 0.00% and 16.67%,respectively.The incidence of gastric emptying disorder in patients with gastric jejunostomy was significantly higher than that in the modified Devine exclusion group,and the difference was statistically significant(P <0.05).The incidences of anastomotic fistula in the two groups were 4.00% and 0.00%,respectively,which were higher in the modified Dvine open surgery group,but the difference was not statistically significant(p> 0.05).One case of anastomotic stricture and one case of tumor bleeding occurred in the gastrojejunostomy group,the incidence was 0.03%,and the difference was not statistically significant(p> 0.05).The total incidence of postoperative complications in the two groups was 4.00% and 22.22%.The incidence of postoperative complications in the modified Devine exclusion group was significantly lower than that in the gastrojejunostomy group,and the difference was statistically significant(P <0.05).The median survival time of patients with modified Devine exclusion surgery was 12 months,while the median survival time of patients with gastrojejunostomy group was only 6 months.Patients and their families were satisfied with the effect of modified Devine exclusion.(92%)was significantly higher than gastrojejunostomy(61%),and the difference was statistically significant(p <0.05).Conclusion: 1.Modified Devine exclusion.is a safe and effective surgical method worthy of popularization and application.2.The incidence of postoperative complications was lower in patients with modified Devine exclusion,especially the gastric emptying disorder;3.The modified Devine exclusion significantly relieved the symptoms and improved the quality of life of patients after surgery.Patients and their families are more satisfied with the treatment effect of the modified Devine exclusion. |
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