Objective To explore the optimal technique for digestive tract reconstruction of proximal gastrectomy. Methods Fifty-nine patients who underwent proximal subtotal gastrectomy during June 2004 and January 2007 were analyzed retrospectively. All patients were divided into 2 groups according to the styles of reconstruction: one group with gastroesophagostomy (GE group) and the other with accommodation double tract digestive reconstruction of jejunal interposition (GIE group). The reconstruction of GIE group was to interposite a continuous 35 cm jejunum between the gastric stump and the oesophagus, which detail had been reported in our previous literature. The quality of life in 2 groups were evaluated and compared. Results No patient died and there was no anastomotic leakage, dumping syndrome and moderate or severe anemia occurred during perioperative period. There was no significant difference of the following indexes of nutrition between 2 groups 1 month and 6 months after operation: the value of weight, RBC, Hb, Alb, PNI and the indexes versus the preoperative ones (Pgt;0.05), for the exception of the indexes of RBC (P=0.006), Hb (P=0.001) in 1 month after operation versus the preoperative ones. The abdominal and the reflux esophagitis symptoms in GIE group were milder than those in GE group (Plt;0.001). The Visick scoring: most of the GIE group were gradeⅡ (74.2%), and grade Ⅲ (64.3%) in the GE group. There was no delay of the first time of adjuvant chemotherapy in GIE group (Pgt;0.05), and the surgical time was (0.35±0.13) h more than that of GE group (P=0.01). Conclusion The accommodation double tract digestive reconstruction of jejunal interposition for proximal subtotal gastrectomy may be safe and feasible by decreasing residual cancer cells and improving the quality of life of patients with proximal gastric carcinoma who underwent such surgical procedure.
The substitution of ρ-shaped jejunum for stomach in 64 patients with gastric carcinoma after total gastrectomy is reported . Survival rate of the first, third anad fifth year afer surgery were 71.8%,42.2% and 34.4% respectively.Postoperative death and complications with fistula of anastomotic stoma , refulx esophagitis and dumping syndrome were not encountered in this all series. These results show that the operative procedure is a simple, safe, and can be accomplished within short time and that the quality of living of the patient is good.
ObjectiveTo explore feasibility and safety of π-shaped esophagojejunal anastomosis in totally laparoscopic total gastrectomy (TLTG).MethodThe clinical data of 20 patients who underwent TLTG, admitted in the Affiliated Hospital of Xuzhou Medical University from January 2018 to December 2018 were retrospectively analyzed.ResultsTLTG with π-shaped esophagojejunal anastomosis was successfully carried out in all 20 patients. The operative time was (236.0±55.5) min, the π-shaped esophagojejunal anastomosis time was (25.7±4.8) min, the intraoperative blood loss was (192.0±148.9) mL, the operative incision length was (3.7±0.8) cm. The postoperative pain score was 2.4±1.1, the first flatus time was (3.1±0.9) d, the first postoperative ambulation time was (1.8±0.7) d, the removal time of nasoenteral nutrution tube was (7.4±2.4) d, the liquid diet time was (6.2±1.4) d, the removal time of intraoabdominal drainage tube was (7.8±2.8) d, the postoperative hospital stay was (10.8±3.0) d. There was no death related to the anastomosis in all patients. Two patients developed a little pleural effusion and 1 patient developed lymphatic leakage were cured with conservative treatment. One patient with intraabdominal encapsulated effusion was cured by puncture and drainage treating. There was no postive incisal margin. The length of upper segment of resection form gastric cancer was (2.3±1.7) cm, the maximum tumor diameter was (4.9±2.8) cm, the number of dissected lymph nodes was 27.9±5.6. All patients were followed up 3–15 months. Eight patients underwent endoscopic examination had no obvious anastomosis stenosis and esophageal reflux. Two patients died of tumor recurrence and metastasis witnin one year after operation, and the rest had disease-free survival until the end of follow-up.ConclusionFrom preliminary results of limited cases in this study, π-shaped esophagojejunal anastomosis in TLTG is a technically safe and feasible surgical procedure in treatment of gastric cancer.
目的 探讨全胃切除术后消化道重建方式的选择。 方法 我院2001年6月至2006年6月期间对182例胃癌患者全胃切除术后分别行空肠ρ袢代胃术(PRY)69例和非离断式食管空肠改良Roux-en-Y吻合术(URY)113例。 分析手术时间、术后进食情况、消化道症状及营养状况的差异。结果 非离断式食管空肠改良Roux-en-Y吻合术手术时间短于空肠ρ袢代胃术，且无Roux潴留综合征（RSS）发生。 2种术式术后患者营养状况并无明显差异。结论 非离断式食管空肠改良Roux-en-Y吻合术操作简单、并发症少、术后恢复良好，可以推荐作为全胃切除术后的消化道重建术式。
ObjectiveTo investigate the application of three methods about digestive tract reconstruction in radical resection for proximal gastric cancer.MethodsWe retrospectively reviewed the cases of 130 proximal gastric cancer patients who underwent double tract reconstruction (TD, 35 cases), total gastrectomy (TG, 50 cases) and esophagogastrostomy (EG, 45 cases) from Jan. 2016 to Oct. 2018 in Gastrointestinal Surgery Department in our Hospital.ResultsThere were no significant differences in basic data of patients, preoperative nutritional status, hemoglobin content, postoperative recovery time of gastrointestinal function, hospitalization time and early postoperative complications among the three groups (P>0.05). But the operative time, intraoperative bleeding volume, postoperative status of total protein, albumin, hemoglobin, late complications, reflux symptoms, gastro-intestinal quality of life index (GIQLI) between the three groups had statistically significant differences (P<0.05). The operative time of EG was (161.80±30.77) min, which was the shortest. The intraoperative bleeding volume of TG was (107.20±10.70) mL, which was the most. At 6 months after TG, the total protein, albumin and hemoglobin were (62.15±6.72) g/L, (36.14±6.57) g/L and (112.68±16.97) g/L, respectively, which were the lowest level among the three groups. There late complications of the EG were the most serious, in which the Visick score was 46 and the GIQLI index was 103.56±22.01. The above differences were statistically significant (P<0.05).ConclusionsDT performs better in anti-reflux, maintenance of postoperative nutrition, and anti-anemia, but the occurrence of remnant gastric cancer is a potential risk. TG has a lot of bleeding, as well as the performance of postoperative nutrition and anti-anemia is not good, but it can avoid the occurrence of remnant gastric cancer. The operative time of EG is short, but reflux symptoms are more likely to occur after surgery, and the quality of life is bad.
Motor function was investigated by constant perfusion manometry in the Roux limb of ten patients who had undergone total gastrectomy and Roux-en-Y anastomosis. Results showed that in the fasting state, the migrating motor complex (MMC) was comletely absent, retrograde in direction or bursts of nonphasic pressure activity. Reduced motor activity patterns occurred after the meal in some patients. Four patients failed to convert fasting state into the feeding state. Total gastrectomy with Roux-en-Y anastomoses provakes a relatively severe distubance in motor function, which could contribute to postoperative upper abdominal distress.
ObjectiveTo systematically evaluate the efficacy and safety of proximal gastrectomy (PG) versus total gastrectomy (TG) for the treatment of Siewert type Ⅱ/Ⅲ adenocarcinoma of the esophagogastric junction (AEG). MethodsPubMed, The Cochrane Library, Web of Science, EMbase, CNKI, Wanfang, and VIP databases were searched for literature comparing the efficacy and safety of PG and TG for the treatment of Siewert type Ⅱ/Ⅲ AEG. The search period was from database inception to March 2023. Meta-analysis was performed using Review Manager 5.4 software. ResultsA total of 23 articles were included, including 16 retrospective cohort studies, 5 prospective cohort studies, and 2 randomized controlled trials. The total sample size was 2 826 patients, with 1 389 patients undergoing PG and 1 437 patients undergoing TG. Meta-analysis results showed that compared with TG, PG had less intraoperative blood loss [MD=−19.85, 95%CI (−37.20, −2.51), P=0.02] and shorter postoperative hospital stay [MD=−1.23, 95%CI (−2.38, −0.08), P=0.04]. TG had a greater number of lymph nodes dissected [MD=−6.20, 95%CI (−7.68, −4.71), P<0.001] and a lower incidence of reflux esophagitis [MD=3.02, 95%CI (1.24, 7.34), P=0.01]. There were no statistically significant differences between the two surgical approaches in terms of operative time, postoperative survival rate (1-year, 3-year, 5-year), and postoperative overall complications (P>0.05). ConclusionPG has advantages in terms of intraoperative blood loss and postoperative hospital stay, while TG has advantages in terms of the number of lymph nodes dissected and the incidence of reflux esophagitis. There is no significant difference in long-term survival between the two surgical approaches.