Study In The Relationship Between The Mode Anastomosis Of Esophageal Jejunal After Total Gastrectomy Reconstructed By Roux-En-Y And Esophageal Reflux

Objective:To investigate the relationship between the reconstruction of esophageal jejunal Roux-en-Y anastomosis and esophageal reflux after total gastrectomy, and thus to select the ideal anastomosis to reduce postoperative esophageal reflux.Methods:To analyze 91 patients who were diagnosed as gastric adenocarcinoma and operated total gastrectomy reconstructed by Roux-en-Y by The Affiliated Tumor Hospital of Guangxi Medical University, among them 21 cases were esophageal jejunal end-to-end anastomosis (groupA),70 cases were esophageal jejunal end-to-side anastomosis(groupB). To compare cases of esophageal reflux in these two groups, and then analyze the length of jejunal stump of esophageal jejunal end-to-side anastomosis in the subgroup of esophageal reflux symptoms and subgroup of no reflux symptoms.Rseults:The esophageal reflux of Group of esophageal jejunal end-to-end anastomosis was significantly higher than group of esophageal jejunal end-to-side anastomosis (66.7% VS 21.4% P0.001). The length of jejunal stump with esophageal reflux in the group of esophageal jejunal end-to-side anastomosis had statistical differences between the length of jejunal stump without esophageal reflux symptoms (2.01±0.81cm VS 3.50±0.42cm P<0.001).With the help of upper gastrointestinal contrast in the cases of reflux subgroup and no reflux subgroup, the jejunal stump of esophageal jejunal end-to-side anastomosis in the reconstructed jejunal Roux-en-Y showed esophageal reflux caused by antiperistaltic wave and played the role of storage bag of chyme and intestinal juice, so as to achieve the effect of anti-reflux.Conclusion:The reconstruction of esophageal jejunal end-to-side anastomosis by esophagus jejunal Roux-en-Y after total gastrectomy and appropriately retain of the length of jejunal stump can effectively reduce postoperative jejunal-esophageal reflux causing by jejunal anastalsis, and it is an ideal reconstruction method to esophageal jejunal anastomosis in the prevention of postoperative esophageal reflux.