Study On Mechanical Mechanism Of Proximal Gastric Antireflux Surgery

In recent years,the incidence of Adenocarcinoma of the esophagogastric junction(AEG)has increased significantly.Traditional surgical options for the treatment of this disease include total gastrectomy and proximal gastrectomy(PG).However,the esophageal reflux after PG severely affects the quality of life of patients,and can bring the risk of reflux esophagitis to patients in severe cases.For the healthy development of patients,it is urgent to improve PG resection to prevent patients from postoperative esophageal reflux.Recently,the team of Professor Gao Yongshun from the First Affiliated Hospital of Zhengzhou University proposed a new set of suture plan for Proximal gastrectomy triangle-valve technique(PG-TVT)based on clinical experience.In order to better apply and continuously optimize the anti-reflux surgery program,this article worked closely with Professor Gao Yongshun to study the mechanical mechanism of anti-reflux surgery from the perspective of biomechanics qualitatively and quantitatively,so as to provide a theoretical basis for the innovation and improvement of the surgical program.The main work of the thesis is as follows:(1)According to the originally proposed PG-TVT surgery plan,establish a simulation model of the patient’s standing and lying down stomach after PG surgery and PG-TVT anti-reflux surgery,and the chyme distribution law obtained through simulation.The results of the study showed that after PG surgery,whether the patient was in a standing or lying position after eating,when the viscosity of the chyme was small,reflux occurred in the stomach,and it was easy to flow out of the cardia.In PGTVT surgery,the triangular flap at the minor curvature of the stomach can block a part of the chyme from flowing to the cardia in a standing position,and it can also prevent the reflux of chyme in a lying position.(2)The postoperative gastric peristalsis model was established,and the study found that the peristaltic wave makes the reverse jet at the pyloric ostium rush to the greater curvature of the stomach,while the reverse jet rushes to the lesser curvature of the stomach without the peristaltic wave.After the operation,the patient is in a standing posture,and the lower viscosity chyme reverse jet rushes to the greater curvature of the stomach,and the improved PG-TVT has a better anti-reflux effect.When the postoperative patient is in the supine posture,the PG-TVT anti-reflux surgery program and the improved PG-TVT anti-reflux surgery program have anti-reflux effects.(3)When the patient lies supine after the improved PG-TVT anti-reflux operation,the triangular flap at the greater curvature of the stomach is attached to the inside of the stomach wall under the action of gravity to play an anti-reflux effect.On this basis,a new proximal gastrectomy program-proximal gastric double-valve anti-reflux resection is proposed,which has a good anti-reflux effect regardless of whether the patient is in a standing or lying position.