| Objective In our study, we aim to explore the reliability and safety of degestive reconstruction of laparoscopic radical total gastrectomy. Laparoscopic Roux-en-Y anastomosis and esophagus jejunum anastomosis triangle "R" type jejunum were adopted in patients with gastric cnacers. The complication of short-term and long-term were compared to explore the clinicla value of esophagus jejunum anastomosis triangle "R" type jejunum replaced the stomach in laparoscopic radical total gastrectomy.Methods 61 patients with gastric cancers were collected from Aprial 2013 to Octomber 2014 in Lanzhou Military Region General Hospital. All the patients were underwent laparoscopic radical total gastrectomy and were devided into two groups:A(Roux-en-Y anastomosis group,31 case); B(Triangle anastomosis,30 cases). Among these patients(42 males and 19 females, aged between 24 and 48 years, with a mean age of 58.6 years),49 cases of patients with gasiric cancer, 12 cases of patients with gastric stump cancer, the average number of lymph node dissection 23.75, lymph node positive tumors was 37.6%, postoperative complication rate was 7.4%, no procedure-related deaths. Based on the 2012 Guidelines of the American National Comprehensive Cancer Network,8 cases were classified as stage Ib(13.1%),41 as stage 11(67.2%) and 12 as stage Ⅲa(19.7%). To analysis and study the surgery patients case, including:the number of lymph node dissection, postoperative complications, reflux esophagitis, dumping syndrome and nutritional status. All patients were followed up for 6-18 months.Results 61 patients were underwent laparoscopic radical total gastrectomy (Roux-en-Y anastomosis esophagus, esophageal anastomosis jejunum triangle). The duration of surgery ranged between 168 and 252 min (average,213.8±21.7 min), triangle anastomosis time was (32.6±1.7) min (p<0.001), the intraoperative blood loss ranged between 36 and 156 ml (average,85.6±23.4 ml) and the number of lymph nodes dissected ranged between 16 and 28 nodes (average, 23.8±4.1). Stomach tube removed on postoperative day 1. The average time to ambulatory activity was 0.9±0.3 days and the average time to oral food intake was 1.8±0.2 days. Postoperative fart for the first time was 2.9±0.5 days, the average hospital stay time after surgery was 7.9±0.8 days. One patient developed a post-operative reflux esophagitis in triangle anastomosis group (p=0.012). Anastomotic area in triangle anastomosis group was 10.83 cm2, which is three times than the tube-type anastomosis. All patients had no anastomotic stricture, obstruction, bleeding, anastomotic fistula, intra-abdominal infections and other serious complications related to surgery, no perioperative deaths, all the patients recovered discharge All patients were strictly followed up. Six months after surgery, prealbumin concentration in triangle anastomosis group was (177.6±19.7) mg/L (p=0.027), body mass index in triangle anastomosis group was (20.0±1.6) kg/m2 (p=0.021), nutritional status in triangle anastomosis group better than the Roux-en-Y anastomosis group. Eighteen months after surgery, all patients are generally in good condition, such as:normal diet, no weight loss, no eating stems choking, burning sensations, and so on.Conclusions The technique of esophagus jejunum anastomosis triangle "R" type jejunum replaced the stomach in laparoscopic radical total gastrectomy was safety and feasibility. The number of lymph node dissection and safety margin distance were similar to laparoscopic Roux-en-Y anastomosis. Triangle anastomosis have some significantly advantages, such as: expand anastomotic area, avoiding the anastomotic stenosis, reduce the difficulty of laparoscopic anastomosis, to lessen the shortcomings of esophageal jejunal Roux-en-Y anastomosis, anti-reflux, reduce the incidence of postoperative complications, and so on. |
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