| Purpose:To compare and analyze the effects of posterior gastric wall anastomosis and greater curvature of the stomach residual angle anastomosis on Roux-en-Y reconstruction in laparoscopic radical gastrectomy for gastric cancer.Method: A total of 234 patients who underwent laparoscopic radical gastrectomy and Roux-en-Y reconstruction in our hospital from June 2015 to September 2018 were collected.According to the position of gastrointestinal anastomosis,the patients were divided into two groups: posterior gastric wall anastomosis group(Observation group)and greater curvature of the stomach residual angle anastomosis group(Control group).The information collected included the location of gastroenterostomy,gender,age,BMI and serum albumin level at admission,tumor length,p TNM stage,operation time,intraoperative blood loss,number of lymph nodes removed,postoperative first exhaust time,first defecation time,postoperative indwelling time of gastric tube,postoperative hospital stay,and serum albumin level 1 month after operation.The incidence of bile reflux,residual gastritis,reflux esophagitis,albumin level,BMI and weight loss at 1 year after operation.Collate the data and use SPSS24.0 software for data analysis.Quantitative data are expressed in terms of ?± or median and quartile spacing,and independent sample t-test or rank sum test are used for inter-group comparison;The qualitative data were expressed as percentage,and chi-square test or correction for continuity chi-square test was used in the comparison between groups.Rank sum test is used to compare ordered variables.The relevant clinical and follow-up data were compared and analyzed.P < 0.05 was taken as the standard of significant difference.Result: The median age(64 vs 64 years,P =0.38),gender ratio(male / female: 63/30 vs 97/44,P =0.87),median BMI(24.6 vs 23.9 kg,P =0.12),mean albumin level at admission(38.1 vs 38.3 g/L,P =0.69),The median maximum diameter of the tumor(3.0 vs 3.0cm,P = 0.14),TNM stage[(Ⅰ/Ⅱ/Ⅲ): 18/36/39 vs 31/53/57,P= 0.89)].There was no significant difference in general clinical and pathological data between the observation group and the control group.The median operation time(250.8 vs 258.4 min,P=0.20),the median number of lymph nodes dissected(26.8 vs 26.1,P=0.25),the median intraoperative blood loss(100 vs 100 ml,P=0.20),the median first exhaust time(3.0 vs 3.0 days,P=0.22),Median first defecation time(4.0 vs 4.0 days,P=0.10),postoperative indwelling time of gastric tube(4.0 vs 4.0 days,P=0.06),the average serum albumin level after operation one month(36.0 vs 36.0 g/L,P=0.99).There was no significant difference in the situation related to operation and the recovery of gastrointestinal function after operation.There was no significant difference in the incidence of anastomotic leakage between the two groups(2.15% vs 2.84%,P=1.00).The incidence of postoperative gastroparesis syndrome(2.15% vs 8.51%,P=0.08)was not statistically significant.The severity of postoperative gastroparesis syndrome [(mild/moderate/severe): 1/1/0 vs 3/2/7,P=0.04].The severity of postoperative gastroparesis in the observation group was significantly lower than that in the control group,and the difference was statistically significant.One year after operation,the average albumin level(39.1 vs 38.4g/L,P=0.22),the average BMI(23.7 vs 23.0kg/m2,P=0.13),the median weight loss rate(4.00% vs 3.87%,P=0.73),the incidence of bile reflux(15.05% vs 14.18%,P=0.78),the incidence of remnant gastritis(11.83% vs 8.51%,P=0.40),the incidence of reflux esophagitis(8.60% vs 8.51%,P=0.98).There was no significant difference between the two groups(P> 0.05).Conclusion: In Roux-en-Y reconstruction after laparoscopic distal gastrectomy,posterior gastric wall anastomosis does not increase the difficulty of operation,has no significant effect on the anti-alkaline reflux ability of Roux-en-Y reconstruction,and has little effect on nutritional status 1 year after operation,but posterior gastric wall anastomosis can reduce the occurrence of postsurgical gastroparesis syndrome,and has obvious advantages in reducing the severity of postsurgical gastroparesis syndrome. |
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