Clinical Observation Of Therapeutic Effects On Different Types Of Alimentary Tract Reconstructions After Total Gastrectomy

Objective:To investigate the clinical effect of four different types of alimentary tract reconstructions after total gastrectomy for gastric cancer who has finished the operation.To compare the differences of the average operative time,operative mortality,average intraoperative bleeding volume,postoperative anal exhaust time,postoperative hospitalizat ion days,postoperative complications rate,gastrointestinal symptoms in the four different types of alimentary tract reconstructions.Methods:Collect and retrospectively analysis the clinical data of 208 patients with gastric cancer who had be in hospital and accepted total gastrectomy and be followed up in Affiliated Hospital of Taishan Medical College from Sep.2006 to Sep.2016.According to the different digestive tract reconstruction after total gastrectomy in the operation,they were divided into four groups: A group Roux-en-Y jejunal interposition(135cases),B group Moynihan jejunal interposition(24cases),C group Jejunum interposition(19cases),D group Roux-en-Y cavity anastomosis(30cases).To compare the differences between the four groups of patients who had accepted the operation on the operative time,operative mortality,intraoperative bleeding volume,postoperative anal exhaust time,postoperative hospitalization days,postoperative complications rate,gastrointestinal symptoms.To evaluate the advantages,disadvantages and clinical efficacy of four different types of alimentary tract reconstructions systematively.Results:Although the incidence of postoperative complications in the four groups of patients with different types of alimentary tract reconstructions was different,but there was no significant difference between the four groups(P>0.05).In terms of postoperative gastrointestinal symptoms,Among the 135 cases in Roux-en-Y jejunal interposition group,there were 11 cases(8.15%)of reflux esophagitis occurred after operation,dumping syndrome in 16 cases(11.85%),satiety in 10 cases(7.41%),diarrhea in 3 cases(2.22%);Among the 24 cases in Moynihan jejunal interposition group,there were 9 cases(37.50%)of reflux esophagitis occurred after operation.dumping syndrome in 1 case(4.17%),satiety in 1 cases(4.17%);Among the 19 cases in Jejunum interposition group,there were 1 case(5.26%)of reflux esophagitis occurred after operation.satiety in 2 cases(10.52%),diarrhea in 1 cases(5.26%);Among the 30 cases in Roux-en-Y cavity anastomosis group,there were 1 case(3.33%)of reflux esophagitis occurred after operation,diarrhea in 1 cases(3.33%);In terms of reflux esophagitis,the incidence rate in Moynihan jejunal interposition group was 37.50%(9/24)was significantly higher than that of the other three groups,and the difference was statistically significant(P<0.05);In terms of postoperative dumping syndrome,Roux-en-Y cavity anastomosis group has the advantage compared with Roux-en-Y jejunal interposition group,and the difference was statistically significant(P<0.05);There was no statistically significant(P>0.05)between the four groups in postoperative satiety and diarrhea;There was no statistically significant(P>0.05)between the four groups in the four terms of operative mortality,average intraoperative bleeding volume,postoperative anal exhaust time and postoperative hospitalization days.In the term of the average operative time,Roux-en-Y jejunal interposition group(194.36±09.24min)and Moynihan jejunal interposition group(205.90±13.16min)were shorter than Jejunum interposition group(236.09±15.93min)and Roux-en-Y cavity anastomosis group(240.19±1 2.69min),the difference was statistically significant(P<0.05).Conclusion:Roux-en-Y jejunal interposition has the advantage in the time of operation than Jejunum interposition and Roux-en-Y cavity anastomosis,has the advantage in the incidence rate of reflux esophagitis than Moynihan jejunal interposition.After constructing the bag,the incidence of dumping syndrome of Roux-en-Y cavity anastomosis group was lower than that of Roux-en-Y jejunal interposition group.There was no significant difference between the four groups in the incidence of general complications and gastrointestinal symptoms such as diarrhea and satiety.At present,because of the shorter operation time,smaller number of anastomotic stoma,simple and easy to operate,be safe and reliable for the patients,good short-term effect,the Roux-en-Y jejunal interposition is still the rational alimentary tract reconstruct ion after total gastrectomy.However,the construction of the bag can reduce the occurrence of postoperative dumping syndrome,improve postoperative quality of life,when the patients belong to the early and middle stage of gastric cancer who are likely to have long-term survival,the Roux-en-Y cavity anastomosis may be considered.