Evaluation And Analysis Of The Safety And Long-Term Effect Of Folded Jejunal Interposition Double-Tract Reconstruction

Objective: To analyze the safety,effectiveness and long-term effect of Folded Jejunal Interposition Double-tract Reconstruction technique in proximal gastrectomy,in order to explore the ideal method of digestive tract reconstruction after proximal gastrectomy and provide clinical evidence.Method: Collect data from patients who were diagnosed with upper gastric or esophagogastric junction cancer(Siewert Ⅱ or Ⅲ)and treated with proximal gastrectomy at the Gastrointestinal Surgery Department of the First Affiliated Hospital of the Air Force Medical University from January 2010 to December 2019.All patients underwent preoperative diagnosis through gastroscopy,pathology,and abdominal CT,and no distant metastasis.They did not receive radiotherapy,chemotherapy,or immunotherapy before surgery,and the tumor resection met the R0 resection standard.According to the different surgical methods,they are divided into three groups: Folded Jejunal Interposition Double-tract Reconstruction group(FJIDTR group),Esophagogastrostomy group(EG group)and Tube-like Stomach Esophagogastrostomy group(TEG group).Observe the surgical time,blood loss,lymph node clearance,positive number of lymph nodes,hospital stay,gastric tube drainage volume,postoperative ventilation time,gastric tube removal time,early postoperative complications(anastomotic leakage,bleeding,intestinal obstruction,lung infection),anastomotic stenosis,long-term effects(Gerd Q reflux score,weight loss,anemia,reflux esophagitis,quality of life),etc.Results:395 people were included in this study,including 140 in the FJIDTR group,94 in the TEG group,and 161 in the EG group.The operative time of TEG group was shorter than that of FJIDTR group and EG group(P < 0.001),and the operative time of EG group was shorter than that of FJIDTR group(P=0.001).The bleeding volume in the TEG group was lower than that in the EG group(P=0.006),while the bleeding volume in the FJIDTR group was similar to that in the EG and TEG groups,with no statistically significant difference(P > 0.05).There was no statistically significant difference among the three groups in terms of lymph node dissection,lymph node positivity,unplanned secondary surgery,and blood transfusion(P > 0.05).In the FJIDTR group,5(3.6%)patients had pulmonary infection,1(0.7%)patient had intestinal obstruction,and no patients had anastomotic leakage or bleeding.1(0.7%)patient had anastomotic stenosis;In the TEG group,5(5.3%)patients had pulmonary infections,1(1.1%)patient had postoperative anastomotic fistula,3(3.1%)patients had postoperative bleeding,and no patients had intestinal obstruction,and 1(1.1%)patients had anastomotic stenosis;In the EG group,4(2.5%)patients had pulmonary infections,3(1.9%)patients had postoperative anastomotic leakage,2(1.2%)patients had postoperative bleeding,3(1.9%)patients had intestinal obstruction,and 7(4.3%)patients had anastomotic stenosis.There was no statistically significant difference among the three groups in terms of anastomotic leakage,bleeding,intestinal obstruction,pulmonary infection,and anastomotic stenosis(P > 0.05).The hospitalization time of TEG group patients was shorter than that of FJIDTR group(P< 0.001)and EG group(P < 0.001).The gastric tube drainage volume in TEG group was lower than that in EG group(P < 0.001)and FJIDTR group(P < 0.001).The time of gastric tube removal in TEG group was earlier than that in EG group(P < 0.001),while the time of gastric tube removal in the FJIDTR group was earlier than that in the EG group(P <0.001).The postoperative ventilation time in the TEG group was earlier than that in the EG group(P=0.005).The scores of heart burn,reflux,epigastrium pain,nausea,sleep disturbance at night and taking additional drugs in FJIDTR group were better than those in TEG group(P < 0.05)and EG group(P < 0.05).The total Gerd Q score of the FJIDTR group was significantly better than that of the TEG group(P<0.001)and the EG group(P< 0.001).The incidence of reflux esophagitis in the FJIDTR group was significantly lower than that in the EG group(P < 0.001).The postoperative weight loss in the FJIDTR group was less than that in the TEG group(P<0.001)and EG group(P<0.001),while the postoperative weight loss in the EG group was less than that in the TEG group(P<0.001).The average postoperative weight loss rates in the FJIDTR group,TEG group,and EG group were 10.58%,22.84%,and 15.96%,respectively.The overall health status of the FJIDTR group after surgery was better than that of the TEG group(P<0.001)and the EG group(P<0.001).The FJIDTR group had better insomnia symptoms than the EG group(P<0.001).There was no statistically significant difference among the three groups in areas such as physical function,role function,emotional function,cognitive function,social function,fatigue,pain,shortness of breath,loss of appetite,constipation,diarrhea,and economic difficulties(P>0.05).There was no statistically significant difference in overall survival among the three groups(P=0.096).Conclusion: Folded jejunal interposition double-tract reconstruction has good surgical safety and does not increase the incidence of short-term complications such as postoperative anastomotic leakage,bleeding,intestinal obstruction,lung infection,etc.,nor does it increase the incidence of long-term complications such as anastomotic stenosis and anemia;It is significantly superior to the esophageal tubular gastric anastomosis group and the esophageal gastric anastomosis group in terms of antireflux,and the incidence of reflux esophagitis is low;This surgical method has certain advantages in maintaining postoperative weight and long-term quality of life,and can be one of the ideal surgical methods for gastrointestinal reconstruction after proximal gastrectomy.