| Background and Objective: In China, gastric cancer is one of the most common malignant tumors, which seriously threatenes human health. People died of gastric cancer each year is on the top of various malignant tumors. At present, the main treatment of gastric cancer is surgery based on the comprehensive therapy. For carcinoma in the lower third of stomach people mainly resect more than 2/3 of the distal stomach, and cut off the vagus nerve, thus destructs the continuity and integrity of digestive tract, disruptes the normal neurohumoral regulation, the gastric function also greatly changes which is manifested as gastric peristalsis weakening, pyloric pressure increasing, gastric emptying resistance increasing, the emptying time extending and partly loss of the function of gastric storage, food mixture and digestive juice secretion at the same time, seriously affects food digestion and absorption, and often causes a series of sequelae such as anorexia, delayed gastric emptying, postoperative malnutrition and diarrhea, leads to partly loss of the ability of the working and living, even can be life-threatening, seriously affects the life quality of the patients.Recently, the resection range of gastric cancer and the extent of lymph node dissection have been re-definited, under the principle of striving for radical cure, people start to pay more attention to preserve important blood vessels, nerves and organs (such as pylorus). This research studies the effect of a new operation type--the celiac branch of vagus nerve-preserving gastrectomy, analysis of the feasibility and clinical application of this technique from hormone level.Methods: We followed-up 85 postoperative patients with carcinoma in the lower third of stomach in general surgery department, the First Affiliated Hospital of Dalian Medical University from January 2006 to April 2007, 59 cases were successfully followed-up, 39 cases were male, 20 cases were female. 32 cases for gastrectomy with the celiac branch of vagus nerve preservation, and 27 cases without the celiac branch of vagus nerve preservation. Evaluation on hospital clinical index, postoperative subjective symptoms, nutritional status and life quality score between the celiac branch of vagus nerve-preserving group and the not-preserving group. Measurement of serum gastrin, insulin, plasma glucagon, pancreatic polypeptide levels of the celiac branch of vagus nerve-preserving group and the not-preserving group. 14 normal subjects and 21 patients with carcinoma in the lower third of stomach before surgery, detection of basal serum gastrin, insulin, plasma glucagon, pancreatic polypeptide levels served as control groups. Some patients of the celiac branch of vagus nerve-preserving group, the celiac branch of vagus nerve not-preserving group, the normal group and the preoperative group drew blood again two hours post meal in the morning, measured plasma pancreatic polypeptide level. Comparison of postprandial plasma pancreatic polypeptide level among these four groups.Results: At subjective symptoms aspects such as appetite, postprandial abdominal distension and diarrhea, the celiac branch of vagus nerve-preserving group is significantly better than the preserving group (P values are 0.035,0.017 and 0.016). The preserving group is significantly earlier than the not-preserving group in terms of anal exsufflation time (P=0.009), the preserving group is 3.6±0.9 days, and the not-preserving group is 4.3±1.0 days. Albumin and total protein of the celiac branch of vagus nerve-preserving group are significantly higher than that of the not-preserving group (P values are 0.004 and 0.003), The life quality score of the preserving group is significantly better than that of the not-preserving group (P=0.019).Basal serum gastrin level of the carcinoma in the lower third of stomach group is significantly lower than the normal group, the postoperative group is significantly higher than the normal group and preoperative group (P<0.05), the celiac branch of vagus nerve-preserving group is significantly lower than the not-preserving group, closer to the normal group. There was no significant difference about basal insulin and glucagon levels among the normal group, the preoperative group, the celiac branch of vagus nerve-preserving group and the celiac branch of vagus nerve not-preserving group (P values are all greater than 0.05). There was no significant difference about basal plasma pancreatic polypeptide level between the normal group and the preoperative group (P=0.863), the postoperative group is significantly lower than the normal group (P<0.05), the celiac branch of vagus nerve-preserving group is significantly higher than the not-preserving group, closer to the normal group. Postprandial plasma pancreatic polypeptide of the postoperative group is significantly lower than the preoperative group (P<0.05), the preserving group is significantly higher than the not-preserving group, closer to the normal group.Conclusion: 1. Subjective symptoms (such as appetite, postprandial abdominal distension and diarrhea) of the celiac branch of vagus nerve-preserving group is significantly superior to not-preserving group, The preserving group is significantly earlier than the cutting group in terms of anal exsufflation time2. The celiac branch of vagus nerve-preserving group is significantly higher than the not-preserving group in terms of albumin and total protein level, The quality of life of the preserving group is significantly better than the not-preserving group.3. Basal serum gastrin level: The carcinoma in the lower third of stomach group is significantly lower than the normal group, the postoperative group is significantly higher than the normal group and preoperative group, the celiac branch of vagus nerve-preserving group is significantly lower than the not-preserving group, closer to the normal group. Basal serum insulin and plasma glucagon levels: There was no significant difference among the normal group, the preoperative group, the celiac branch of vagus nerve-preserving group and the celiac branch of vagus nerve not-preserving group. Basal plasma pancreatic polypeptide level: There was no significant difference between the normal group and the preoperative group, the postoperative group is significantly lower than the normal group, the celiac branch of vagus nerve-preserving group is significantly higher than the not-preserving group, closer to the normal group. Postprandial plasma pancreatic polypeptide: The postoperative group is significantly lower than the preoperative group, the preserving group is significantly higher than the not-preserving group, closer to the normal group.
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