Comparison Of Short-term Therapeutic Effects On Four Types Of Alimentary Tract Reconstructions After Total Gastrectomy

ObjectiveTo investigate the rational alimentary tract reconstruction after total gastrectomy byevaluating the patients, hospitalization term、postoperative complications and the incidencerate of digestive symptom(abdominal distension、diarrhoea、reflux esophagitis、dumpingsyndrome、Roux-en-Y stasis syndrome and so on)who accepted the different alimentarytract reconstructions.MethodsFrom July1989to October2011, eight different types of alimentary tractreconstructions were performed in211cases of total gastrectomy for gastric malignanttumor in affiliated hospital of Taishan Medical College. Now there are a great variety ofalimentary tract reconstructions, but most of which derived from the esophageal jejunalRoux-en-Y anastomosis、jejunal interposition and loop-type anastomosis. Four generaltypes of alimentary reconstruction methods were performed after total gastrectomy in184cases. According to reconstruction type, they were divided into four groups: A group (132cases) esophageal jejunal Roux-en-Y anastomosis, B group (18cases) jejunal interposition,C group (23cases) loop-type anastomosis, D group (11cases) Roux-en-Y double-cavityanastomosis. Through looking up their peri-operation period medical records, we couldacquire their hospitalization term、postoperative complications and the incidence rate ofdigestive symptom. By analyze these, we could observe the qualities and defects ofdifferent anastomosis and short-term therapeutic effects.ResultsThere were no significant differences in4groups among hospitalization term、postoperative complications (P>0.05). The incidence rate of reflux esophagitis inloop-type anastomosis group(36.36%)was more higher than other groups(6.82%、5.56%、0.00%). This difference had statistical sense. But this difference had no statistical sense in the other3groups(P>0.05). The incidence rates of abdominal distension、diarrhoea、dumping syndrome、 Roux-en-Y stasis syndrome in the Roux-en-Y double-cavityanastomosis group were lower than other groups. But this difference had no statisticalsense.(P>0.05) The same was true of other3groups(P>0.05).ConclusionThe esophageal jejunal Roux-en-Y anastomosis had the merits of easy operation、fewpostoperative complications and antireflux. So the esophageal jejunal Roux-en-Yanastomosis was the rational choice. And it should be the first choice. The loop-typeanastomosis was easy and timesaving, but the incidence of reflux esophagitis was higher,and the recent therapeutic effect was worse. So it should not be the first choice. The jejunalinterposition could make the food through duodenum, but the incidence of digestivesymptoms wasn ’t lower than the esophageal jejunal Roux-en-Y anastomosis, andfurthermore it had the defects of more stoma and complicate operations. So it also shouldnot be the first choice. Though Roux-en-Y double-cavity anastomosis had low digestivesymptoms, this difference had no statistical sense, and the recent effect was not more betterthan Roux-en-Y anastomosis,s.