Clinical Observation Of Three Different Digestive Tract Reconstruction After Total Gastrectomy

Objective:To observe the prognosis after total gastrectomy for 3 different type of anastomosis : Double Braun anastomosis, P type Roux-en-Y anastomosis and Jejunal Interposition anastomosis. Methods:A retrospective analysis of the fellowship at Colorectal & Anal Surgery department of China-Japan Union hospital of jilin university between January 2012 and June 2015 total resection in 70 cases. And depending on the use of digestive tract reconstruction into double Braun anastomosis group(DB group), P type Roux-en-Y anastomosis group(PR group) and Jejunal Interposition anastomosis(JI group),organize each group’s preoperative, intraoperative data, and collect patients quality of life, nutritional status, alkaline reflux esophagitis and intestinal obstruction and other complications, the patients were followed up by observed prognosis. All the resulting data is processed on the count data using χ2 test, measurement data using t test for, among groups were compared using ANOVA or pairwise comparison, the data are expressed as mean ± standard the difference between(x(-) ± s) expressed in the form using SPSS 19.0 software, when P <0.05,means there are significant differences. Results:1.The quality of life after surgery: after six months, loss of appetite, heartburn circumstances score DB Group and PR group were slightly higher than the JI group, P <0.05; difficult swallowing, vomiting score DB group, PR group were slightly higher than the JI group, P <0.05. After a year, almost the same three groups of patients, no significant difference in scores between the groups. 2. Nutritional Status Results: All three groups after six months to detect serum albumin levels in patients with digestive tract reconstruction, DB Group is slightly better than the JI group, P <0.05. When after a year, no significant differences in serum albumin levels between the groups. When after six months and one year, no significant difference in hemoglobin levels between the groups. Three groups of patients after six months and one year average number of prognostic nutritional index was> 45, that the three groups of patients after good nutrition. But six months after the surgery DB Group and PR group were slightly better than the JI group, P <0.05. There was no significant difference between the groups at one year point after surgery. 3. Postoperative complications: Alkaline reflux esophagitis incidence of JI group rate slightly higher than the other two groups, but every two groups’ P > 0.05, no significant difference were found. Between each group there was no significant difference in postoperative adhesion ileus. Conclusion:1.Six months after total gastrectomy,patients who had P type Roux-en-Y anastomosis and Double Braun anastomosis had a better quality of life and nutritional status after surgery, patients who had Jejunal Interposition anastomosis had some problems such as the presence of reflux in patients with anastomosis,poor postoperative nutritional status. 2.A year after the total gastrectomy,all three types of digestive anastomosis had received a good postoperative quality of life and nutritional status.