The Clinical Study Of Continual Jejunal Interposition Of Stomach And Dodecadactylon After Subtotal Gastrectomy

ObjectiveTo investigate the clinical effect of continual jejunal interposition for the reconstruction of digestive canal in subtotal gastrectomy.MethodsSeventy patients with gastric cancer were randomly divided into 2 groups:Group A (n=34) and Group B(n=36).After subtotal gastrectomy,end-to-side anastomosis was conducted in the group A respectively between gastric stump and jejunum, dodecadactylon and jejunum,then jejunum was anastomosed side to side.Completed continual jejunal interposition would take the place of stomach after ligating and blocking afferent loop jejunums which respectively coincide with gastral jejunum and duodenal jejunum.In the group B,the digestive canal was reconstructed by Billroth II model.At last,comparisons were conducted among the duration of operation, probability of appearing symptom in alimentary canal in three months and six months later,visick ranking index,the amount of plasma-albumin,food intake,and weight between group A and group B,and gastric stump and stoma were inspected by gastroscope.ResultsThere is no one dead in the duration of the operation.Group A and group B respectively used(52±10) minutes and(56±7) minutes in the reconstruction of alimentary canal after operation(t=-1.95 p<0.05).Three months after operation,(11.8%) and(2.9%) in the group A felt abdominal distention and had reflux esophagitis,while they had the proportion of(36.1%) and(22.2%) respectively in the group B.Six months after operation,group A had less abdominal distention(5.9%) and the same reflux esophagitis(2.9%),while group B reduced them to(25%) and(19.4%).The comparison of nutrition condition after operation:In three months,the amount of plasma-albumin in group A and group B averagely declined(3.2±2.9) g/L and(5.7±5.3) g/L respectively. Compare their values,t=2.33,p < 0.05.PNI index were(47.4±4.4) in the group A and (45.2±6.5) in the group B.Equally,comparing result is t=2.65,P < 0.05.However,in six months,the reduction of plasma-albumin changed to(1.1±1.3) g/L in the group A and (1.5±1.7) g/L in the group B.t=-1.12,p > 0.05.PNI index of A and B respectively came to(50.5±3.7) g/L and(49.4±4.5) g/L.t=1.11,p > 0.05.The comparison of food intake after operation:Three months later,there were(70.6%) who had the food-intake > 300g/d,and(58.8%) who didn't have significant difference in self-conscious of the contain of stomach before and after operation in group A,while there were respectively (33.3%) and(19.4%) in group B.However,six months later,the percentage of food-intake over 300g/d and self-conscious of the stomach contain increased to(82.4%) and(73.5%) in the group A.In the group B,they raised respectively to(55.6%) and (41.7%).The comparison of changes of weight:In three months after operation,group A and group B respectively reduced the average weight(5.6±6.2) kg and(5.3±5.8) kg. (t=0.2,p > 0.05).In six months after operation,group A had been increasing weight rapidly,but the average weight still declined(1.1±7.2)kg comparing before operation. The average weight of group B declined(4.8±9.6)kg.As t=-1.82,P<0.05,there is a significant difference in the weight change between group A and group B in six months later.The comparison of visick rating index:In the former three months,group A had a significant higher value of VisickⅠ+VisickⅡ(which was equal to 85.3%) than group B (that is 75%).Six months after operation,it was in the same case.The only difference is the values of Visick I +Visick II increased to(91.2%) in group A and(86.1%) in group B.ConclusionThe continual jejunal interposition enables food to go through dodecadactylon to keep physiological continuity of digestive canal,reduces the difficulty of reconstructing alimentary canal in subtotal gastrectomy,and avoids bile regurgitating,so that patients will have a better recovery of digestive function and life quality after operation.