| BACKGROUND AND PURPOSE:Surgical treatment is the first curative treatment option for cardia carcinoma.It is generally considered that proximal gastrectomy is fit for TNM stage I and II[1] ,and is to prevent or minimize complication that diminish the patient's quality of life(QOF).These include reflux esophagitis,clumping syndrome,and nutritional disturbances after total gastrectomy.Zhang Dawei et al~[2] and Zhang Rugang et al~[3] reported that proximal gastrectomy was a routine procedure for cancer of cardia.The esophagogastrostomy is the routine procedure of digestive tract reconstruction after proximal gastrectomy for cardia carcinoma.But a high incidence of reflux esophagitis diminished the QOF severely~[10].So how to prevent or reduce the incidence of reflux esophagitis is a difficult problem. Some improved esophagogastrostomy was utilized to minimize the occurrence of gastroesophageal reflux, these include anastomosis encasing-in style," scarf"style, etc.But no significant differences were found in these anastomosis styles~[14].A new reconstruction procedure as antireflux surgery after proximal gastrectomy—interposition of the jejunal segment—was reported that it has satisfactory to excellent results~[4,5,6,12,13].In order to objectively evaluate the effect of jejunal interpositionreconstruction in preventing reflux esophagitis after proximal gastrectomy in cardia carcinoma,ninty-five patients with cardia carcinoma were underwent approximal gastrectomy, in which 35 cases by jejunal interposition reconstruction (group JI), and 60 cases by esophagogastro-anastomosis (group EG). Twenty-four-hour esophageal pH monitoring, endoscopy and esophageal biopsy were compared in the two groups.Method:1. Including and excluding standard:(1) Including standarda. The adenocarcinoma in the gastric cardia is diagnosed by fiberoptic gastroscopy and tissue biopsy, and barium examination supports it. b. tumor size less than 4 cm; gross findings indicating a superficial type of lesion;no metastases to # 4, # 5, # 6 lymph node.The operation TNM stage is 0, I, II.(2) Excluding standarda. Squamous cell carcinoma of the esophagus near gastric cardia.b.Distant metastases c.tumor size bigger than 4 cm; gross findings indicating a superficial type of lesion; metastases to # 4, # 5, # 6 lymph node.The operation TNM stage is III,IV.2. Assemble the data:Between October 1995 and October 2003 data were prospectively obtained on our 95 consecutive cases of cardia carcinoma patients who were operated proximal gastrectomy. We gathered the detailed clinical data of these patients, including sex,age, the procedure of digestive tract reconstruction after proximal gastrectomy, histologic classification, TNM stage,postoperative complications,Twenty-four-hour esophageal pH monitoring, endoscopy and esophageal biopsy.3. data analyzing:(1) pH score, number of reflux, episodes longer than 5 minutes, the percentage of reflux time with pH<4 in the upright period, supine period, and total percent of time with pH<4, endoscopic examination and histological evaluation of esophageal biopsy specimens werecompared in the two groups.(2) All the data were analyzed by SPSS11.5 for windows. We chose different statisticalmethod depended on the different data information.Result:(1). Between October 1995 and October 2003,95 patients with cardia carcinoma underwent proximal gastrectomy. Jejunal interposition group consisted of thirty-five patients (thirty men and five women,median age of 62.9 years,range of 43-75 years), esophagogastro-anastomosis group consisted of sixty patients (fifty-one men and nine women,median age of 61.5 years,range of 37-77 years).(2).pH score, number of reflux, episodes longer than 5 minutes, the percentage of reflux time with pH<4 in the upright period, supine period, and total percent of time with pH<4 were significantly lower in group JI than that in group EG(P<0.001). Both endoscopic examination and histological evaluation of esophageal biopsy specimens revealed that the reflux esophagitis in group EG were significantly severe than that in...
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