Research Intrathoracic Stomach (Tube Stomach) After Esophagectomy In The Perioperative Period Changes Of Electrogastrogram

Bjective: Esophageal resection is the the preferred treatment for the midtreatment of early esophageal cancer, Esophageal resection and reconstructionof the upper gastrointestinal tract is a key step in the operation, now the mostcommon esophageal replacement organs is the stomach. In the process of uppergastrointestinal surgery, cut off the vagus nerve, blood arteriovenous and partof the gastric body, and also changed the external environment of stomach.Afterthat， The thoracic stomach（tube stomach）whether to retain the basic physicalcharacteristics and function, or it only as a food channel current research also isnot very clear. This paper will study thoracic stomach（tube stomach）gastricelectrical activity characteristics and trends in perioperative period. And alsodiscuss the reason and the significance, To provide reference data for clinicalphysicians in the prevention and treatment of thoracic gastric dynamic disordersafter esophagectomy, also for the basis research of the thoracic gastricfunction.Methods: This study selected patients in the sichuan provincial cancer hospitala thoracic surgery ward in Period of March2013to November2013. Recordthe electrogastrogram in the preoperative day, on the third day、7th day、11thday and30th day after operation by MMS eight electrogastrogram. All of themdo a20minutes test electrogastrogram test before and after a meal. And analyzes the following electrogastrogram parameters: frequency, main power,percentage of normal gastric slow wave, the slow gastric slow wave percentage,tachycardia gastric slow wave percentage, postprandial/power ratio, coefficientof dominant frequency instability. The measurement data were recorded asmean standard deviation (X±S), the use of paired comparison sample mean(paired Samples T Test) method carries on the comparison to mean twodifferent sets of data, at the same time,use the repeated data of variance analysis(Reapeated Measure) on the postoperative time difference in electrogastrogramparameters before and after meals. All calculation are conducted by SPSS17.0software, P <0.05was considered statistically significant, P <0.01is thought tohave a significant statistical differences.Results:1. The dorminant frequency in the preoperative and postoperative3th day, on the7th day,11th day and30th day are: before the meal (2.83±0.13cpm;2.25±0.10cpm;2.42±0.08cpm;2.53±0.09cpm;2.66±0.10cpm) after ameal (3.01±0.17cpm;2.43±0.08cpm;2.58±0.09cpm;2.72±0.10cpm;2.82±0.10cpm), Compared with the adjacent group mean it is statistical significance（T value：Before a meal：20.77、7.21、7.35、6.83；After a meal：19.05、7.20、6.10、5.50，p＜0.01），variance of postoperative time factor and time andmeal interaction factors results：time factor：F=285.62，P＜0.01，time and mealinteraction factors F=0.22，P=0.876.The dominant frequency instability coefficient respectively are：before ameal (0.133±0.031;0.233±0.031;0.195±0.014;0.161±0.010;0.150±0.043), after a meal (0.045±0.019;0.192±0.017;0.164±0.015;0.137±0.009;0.115±0.010), T test results: before a meal:18.24、7.59、13.80、1.44；after a meal:32.07、11.68、11.92、11.72, The difference is statistically significant(p＜0.01)except the11th group and30thgroup(p=0.16).2. The dominant power respectively are: before a meal (85.02±14.88uV;35.03±6.41uV;49.52±7.02uV;60.65±9.96uV;73.80±8.85uV), after a meal(149.34±22.51uV;50.25±7.40uV;66.25±7.63uV;84.09±8.14uV;98.14±10.17uV), Compared with the adjacent group mean it is statistical significance（T value：Before a meal:15.36,8.70,7.67,8.05; after the meal:24.23、8.12、12.58、12.33，p＜0.01）.variance of postoperative time factor and time and mealinteraction factors results：time factor：F=480.45，time and meal interactionfactors F=7.39，P＜0.01.3.The posprandial to fasting power ratio respectively are:3.00±0.35;1.35±0.27;1.73±0.28;2.06±0.28;2.52±0.25, ompared with the adjacent groupmean it is statistical significance（T value：:26.66；9.97;8.78;16.51,p＜0.01).4.The DF in Normal Range respectively are: before a meal (80.86±5.61%;26.57±4.48%;39.41±3.43%;47.57±3.83%;57.27±4.96%), after a meal(93.95±4.80%;39.89±3.78%;52.25±4.71%;61.39±4.41%;70.34±4.82%).The bradygastria respectively are: before a meal (16.72±6.84%;66.64±7.34%;48.91±6.42%;39.14±4.81%;32.34±4.11%), after a meal (3.83±4.48%;46.80±4.48%;35.29±4.38%;27.27±4.22%;21.49±4.39%).Thetachygastria respectively are: before a meal (1.72±3.57%;6.05±3.49%;8.78± 3.66%;8.56±2.99%;9.33±3.29%), after a meal (1.91±4.76%;12.74±4.00%;12.24±5.68%;12.46±5.74%;12.45±5.25%). Corresponding adjacent groupmean comparison (t test):The DF in Normal Range difference was statisticallysignificant(t value are: before a meal45.64,15.01,11.58,15.01; after ameal:59.31,14.16,10.58,14.16, P＜0.01); The bradygastria difference wasstatistically significant(t value are: before a meal32.02,21.11,10.21,21.11;after a meal:42.97,14.68,14.01,14.68, P＜0.01);The tachygastria t value are:before a meal7.22,3.58,0.44,1.41, P values <0.01,0.01,0.66,0.17, after ameal t are:13.28,0.76,0.31,0.03, P values <0.01,0.09,0.75,0.97. variance ofpostoperative time factor and time and meal interaction factors results：The DFin Normal Range time factor F=49.36, P <0.01, time and meal interactionfactors F=0.24, P=0.80, The bradygastria time factor F=46.54, P <0.01, timeand meal interaction factors F=18.12, P <0.01, The tachygastria time factor F=9.54, P <0.01, time and meal interaction factors F=0.85, P=0.44.Conclusion: After the esophagectomy, the thoracic stomach still retains thegastric electrical activity before and after the meal.The main frequency, mainpower, after dinner/meal before power ratio, percentage of normal slow waveand the slow gastric dynamic rhythm percentage, tachycardia, the percentage ofdynamic rhythm and frequency instability coefficient were significantdifference compared with preoperative.All parameters in the perioperativeperiod is in a process of dynamic change.1. After the esophagectomy, the frequency of electrogastrogram in both before and after the meal will be significantly reduced, and the instability increases,but the peri-operational period frequency can slowly rising, along with theextension of time frequency instability is reduced.2. After the esophagectomy, the electrogastrogram main power before and aftermeals a preoperative all can obviously decrease, perioperative period can beextended over time is on the rise.3. After the esophagectomy,the dinner/meal before power than will besignificantly reduced after surgery, perioperative period can recover gradually,very few patients have recovered to preoperative status in the perioperativeperiod.4. After the esophagectomy,the rhythm of stomach and chest activity changesthere is a huge difference, but the chest breast still maintains the basiccharacteristics of the rhythm of the stomach. And compared with preoperativegastric rhythm, DF in Normal Range fell sharply after surgery, the bradygastriahas risen sharply, with the extension of time, DF in Normal Range has a certaindegree rise, bradygastria has a certain degree of decline, at the same time inpostoperative patients with inthoracic stomach rhythm activity will be atachygastria which was invalid,the rhythm activities will not change along withthe extension of time after surgery.5. Thoracic gastric (tube stomach) electrical activity is a process of dynamicchange in the perioperative.according to corresponding electrogastrogramchange rules and characteristics, clinicians can early prevention and treatment Gastric dynamic disorders on Patients with esophagectomy.