Effects Of Modified Two-channel Reconstruction And Roux-en-Y Reconstruction On Iron Metabolism And Anemia After Radical Subtotal Gastrectomy For Gastric Cancer

Objective: This study compared the different periods of patients with gastric cancer who underwent radical gastrectomy with regulatory double tract digestive channel reconstruction(R-Dcr)or Roux-EN-Y(RY)reconstruction on the levels of ferritin(SF),serum iron(SI)and total iron binding force(TIBC)and hemoglobin(HGB),and analyze to investigate the influence of different ways of reconstruction of digestive tract on iron metabolism and postoperative anemia in patients with gastric cancer.Methods: The subjects were recruited from patients diagnosed with gastric cancer in 404 Hospital of Sichuan Mianyang from December2019 to April 2021(n=50).The patients were randomly divided into study group(RD group)and control group(RY group).The RD group used radical gastrectomy R-Dcr reconstruction,and the RY group was treated with Roux-en-Y reconstruction.The patients were followed up for 12 months,and the general conditions and clinicopathological characteristics of the patients were recorded in detail.Blood samples were collected at 1month,3 months,6 months,9 months and 12 months after operation to detect SF,SI,TIBC,TS and HGB levels.Spss25.0 statistical software was used for statistical analysis.The effects of the two reconstruction methods on postoperative SF,SI,TIBC,TS and HGB were compared.Results : During the follow-up period,a total of 23 patients were interviewed in the RD group and 24 patients in the RY group.There was no significant difference in age,gender,tumor stage and differentiation between the two methods(P > 0.05).There were no significant differences in operation time,intraoperative blood loss,preoperative BMI,ALB,SF and HGB between the two groups(P > 0.05).The SF level of the two groups continued to decrease during 12 months after operation,and the change of SF level of the two groups was significantly different at12 months after operation(P=0.023),but still within the normal range.The levels of SI and TS in the two groups showed an upward trend during12 months after operation,and there was no significant difference between the two groups(P > 0.05).The TIBC of the two groups gradually increased during the postoperative period,and the difference between the two groups was statistically significant at 1 month after operation(P=0.002),and the increase of RY group was more significant at 9 months and 12 months after operation,but the difference was not statistically significant(P > 0.05).The HGB level of the two groups showed a downward trend at 1 month and 3 months after operation,and the RD group began to increase at 6 months after operation,and returned to normal level at 9 months and 12 months after operation.However,HGB in RY group still decreased at 6 months after operation,and only slightly increased at 9 months and 12 months after operation.There was no significant difference in HGB level between the two groups at 12 months after operation(P > 0.05).Linear regression analysis showed that the correlation between HGB and SF and TS was low in the two groups at1 month and 3 months after operation,and the significance test was not statistically significant(P > 0.05).The correlation between HGB and SF was low in RD group at 6 months after operation,and the significance test was not statistically significant(P=0.077).HGB was significantly correlated with SF at 9 months and 12 months after operation,and HGB was significantly correlated with TS at 6 months,9 months and 12 months after operation,and the significance test was statistically significant(P < 0.05).There was a significant correlation between postoperative SF and preoperative SF in the two groups,and the significance test was statistically significant(P < 0.05).Conclusion :(1)Both R-DCR reconstruction and Roux-en-Y reconstruction after radical subtotal gastrectomy for gastric cancer can cause varying degrees of iron absorption impairment due to changes in digestive tract structure,and R-DCR reconstruction has more advantages in iron absorption.(2)Postoperative iron level was correlated with preoperative iron reserve.(3)Anemia occurs after both types of reconstructive surgery,and the incidence of anemia after Roux-en-Y reconstruction is higher.(4)Anemia after radical subtotal gastrectomy is related to iron metabolism.R-dcr reconstruction is more advantageous than Roux-EN-Y anastomosis in improving iron deficiency anemia after radical subtotal gastrectomy.