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

ObjectiveTo investigate the clinical effect of continual jejunal interposition for the reconstruction of digestive canal after subtotal gastrectomy in comparison with Billroth I anastomosis.MethodsA total of92patients, who were received surgery because of gastric cancer, were divided into2groups according to digestive reconstruction:Group A(n=40) and Group B(n=52). 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 I anastomosis. At last, comparison was conducted among the probability of appearing symptom in alimentary canal in six months and one year later, visick ranking index, the amount of plasma-albumin, food-intake, and body weight between group A and group B, and gastric stump and stoma were inspected by gastroscope.ResultsThe PNI showed no significant difference between the two groups before operation. There was no one dead during the operation. There were no complications such as anastomotic leakage or obstruction in the two groups. The comparisons of complications after operation:Six months after operation, the incidence of ventosity in group A(7.5%) was a little less than that of group B(10%)(P>0.05), while no ventosity occurred in the two groups one year after operation. Six months after operation, the incidence of diarrhea in group A(5%) was a little less than that of group B(5.8%)(P>0.05), while no diarrhea occurred in the two groups one year after operation. The incidence of bile reflux gastritis in the group A(5%) was significantly less than that of group B(7.7%)(P<0.05) six months and one year after operation. The comparison of food-intake after operation:Six months after operation, the percentage of the patients who had the food-intake>300g/d in group A was75%, a little higher than the73.1%in group B(P>0.05). One year after operation, that percentage of group A was95%, still a little higher than the94.2%in group B(P>0.05). The comparison of nutrition condition after operation:compared to that amount before operation, the amount of plasma-albumin in group A and group B both declined six months after operation and raised one year after operation, there was no significant difference between the two groups. The comparison of body weight:compared to the body weight before operation, the body weight in group A and group B both declined six months after operation. However, the body weight of the two groups both raised one year after operation, and group A raised a little more rapidly than group B(P>0.05). The comparison of visick rating index:In the former six months, group A had an equal percentage of Visick I+Visick11(92.5%) with the90.4%of group B. One year after operation, that percentage of group A was95%, while that of group B was92.3%, there was no significant difference between the two groups. Gastroscope which was token one year after operation showed5%of the patients in group A had bile reflux, significantly less than the7.7%of groupB(P<0.05).ConclusionThe continual jejunal interposition of stomach and dodecadactylon is safe, effective and suitable for all the patients who received subtotal gastrectomy. This operation not only can enable food to go through dodecadactylon to keep physiological continuity of digestive canal and provide a larger pouch, but also can avoid bile regurgitation. So that patients will have a better recovery of digestive function and life quality after operation.