| Objective:By comparing the changes of body mass index(BMI),hemoglobin(HGB),serum albumin(ALB),whole blood calcium,vitamin D(25-hydroxyl vitamin D,VitD)of the patients with regulatory dual digestion channel reconstruction(R-Dcr)and Roux-en-Y(RY)reconstruction after total gastrectomy,to further explore the effect of regulatory dual digestion channel reconstruction on the short-term metabolism of calcium in patients with gastric cancer after total gastrectomy.In order to provide a scientific basis for the selection of surgical methods of digestive tract reconstruction after total gastrectomy for gastric cancer,as well as postoperative follow-up and medical intervention.Methods:From April 2015 to April 2018,60 patients with gastric cancer who were to undergo total gastrectomy in Sichuan 404 hospital were included in this study.They were randomly divided into two groups by envelope method,the experimental group by R-Dcr and the control group by RY.All patients were followed up for 12 months after the operation,and their gender,age,BMI and tumor stage were recorded in detail.BMI,HGB,ALB,whole blood calcium,and vitamin D levels of the patients were observed before surgery and at 1,3,6,9,and 12 months after surgery.The patients were divided according to gender,age(≤60 years old,>60 years old)Subgroup.Spss21.0 statistical software was used for statistical analysis.To compare the effects of two reconstruction methods on the changes of BMI,hemoglobin,serum albumin,whole blood calcium and vitamin D in patients after operation.Results:The operation was completed successfully in both groups.During the follow-up period,1 case was lost in the experimental group and 2 cases in the control group,and 57 cases were finally included in the study.There were 34 cases in the experimental group and 23 cases in the control group.There was no significant difference in age,gender,BMI,tumor stage,HGB level,ALB level,vitamin D level and whole blood calcium level between the two groups(P>0.05).At 12 months after operation,BMI,HGB and ALB decreased in both groups,and the decrease of RY group was more obvious than R-Dcr group(P<0.05).According to the review at each time period after the operation,the postoperative whole blood calcium in R-Dcr group was 56.89±2.13mg/L,54.8±1.54mg/L,52.16±1.81mg/L,50.03±1.77mg/L,47.81±1.38mg/L,and VitD was 29.15±2.97ug/ml,17.55±1.24ug/ml,15.11±1.19ug/ml,13.8±1.37ug/ml,and 12.6±1.35ug/ml,respectively.In the RY group,all stages of postoperative whole blood calcium were 54.48±1.42 mg/L,52.13±0.88 mg/L,49.52±1.13 mg/L,47.92±0.95 mg/L,46.49±0.78 mg/L,VitD was 26.57±2.62 g/ml,16.13±0.86 g/ml,13.88±0.87 g/ml,12.64±0.76 g/ml,11.82±0.89 g/ml,respectively.The levels of vitamin D and whole blood calcium in both groups continued to decrease,and the decrease was more significant in the RY group(P<0.05).However,the whole blood calcium levels in the two groups were still within the normal range after the operation.After divided into subgroups according to gender:except for the sixth month,there was no statistical difference in the postoperative total blood calcium of men and women in R-Dcr group(P>0.05),and there was no statistical difference in the postoperative total blood calcium of men and women in RY group(P>0.05).After sub group by age:among the male patients aged 60 years or younger:the comparison of the whole blood calcium level between R-Dcr group and RY group showed that there was no statistical significance in other stages of reexamination except the third month(P>0.05).In male patients over 60 years old,the whole blood calcium level of R-Dcr group was higher than that of RY group(P<0.05);Among female patients less than or equal to 60 years old,the comparison of whole-blood calcium level between the R-Dcr group and the RY group showed no statistical significance at the review at other stages except the 6th month(P>,0.05).Among female patients over 60 years old,the comparison of whole-blood calcium level between the R-Dcr group and the RY group showed that the R-Dcr group was higher than the RY group at all stages(P<0.05).Conclusion:(1)After total gastrectomy with R-Dcr reconstruction and RY reconstruction,the whole blood calcium level decreased and remained in the normal range.The whole blood calcium level of R-Dcr reconstruction was higher than that of RY reconstruction.(2)The effect of the two surgical methods on the level of postoperative whole blood calcium was not significantly correlated with gender,and the whole blood calcium level of patients over 60 years old after R-Dcr reconstruction was higher than that of RY reconstruction;(3)After total gastrectomy,the whole blood calcium and VitD should be monitored,which is of great significance to reduce the complications such as hypocalcemia. |
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