Résumé
Objective:To evaluate the feasibility, safety and efficacy of uncut Roux-en-Y anastomosis, Roux-en-Y anastomosis and Billroth Ⅱ plus Braun anastomosis in laparoscopic-assisted distal gastrectomy for distal gastric cancer.Methods:In the retrospective cohort study, 71 cases of laparoscopic-assisted distal gastrectomy for distal gastric cancer from May 2016 to October 2019 in Tangshan Union Medical College Hospital were selected as the study subject. According to the different reconstruction methods of digestive tract, they were divided into: non disconnected Roux-en-Y anastomosis group (Uncut RY group, 29 cases); Roux-en-Y anastomosis group (RY group, 24 cases); Billroth Ⅱ-braun anastomosis group (B Ⅱ-Braun group, 18 cases). The operation time, digestive tract reconstruction time, intraoperative blood loss, the time to flatus, length of hospital stay, incidence of complication and the changes of nutritional index 1 year after surgery were observed. SPSS 18.0 software was used process the data, the measurement data conforming to normal distribution by Kolmogorov-Smirnov test was expressed by xˉ± s deviation, the measurement data dose not meet the normal distribution was expressed by the median (interquartile range) ( M( Q1, Q3)).Analysis of variance was used to compare the measurement data of normal distribution; Nonparametric rank sum test was used for the comparison between measurement data groups with non normal distribution; Count data were expressed in cases (%), and χ 2 test or Fisher exact probability method was used for composition comparison between groups. Results:In Uncut group, RY group and B Ⅱ-Braun group, the operation time were (196.0±28.8) min, (201.0±28.5) min and (186.4±26.1) min, respectively, the digestive tract reconstruction time were (56.2±13.9) min, (57.8±12.9) min and (51.5±10.0) min, respectively,the intraoperative blood loss were (285.2±85.4) mL, (280.1±78.4) mL and (273.3±79.6) mL, respectively, the time to flatus were (52.5±14.4) h,(53.9±14.6) h and (46.2±9.4) h, respectively, the length of hospital stay were (12.6±2.8) d, (12.1±3.0) d and (12.8±2.6) d, respectively, there were no significant differences among the three groups ( F values were 1.41, 1.33, 0.12, 1.89 and 0.35, respectively; P values were 0.251, 0.271, 0.890, 0.158 and 0.709, respectively). Postoperative complications in Uncut group, RY group and BⅡ-Braun group: The number of cases of anastomotic leakage was 0, 1 and 1, respectively. The number of cases of abdominal bleeding was 1, 1 and 0, respectively. The number of cases of bile reflux gastritis was 2, 1 and 5, respectively, and the number of cases of anastomotic ulcer was 0, 0 and 1, respectively. There were no significant differences among the three groups (Fisher's exact test, P values were 0.510,1.000, 0.063 and 0.254, respectively). The number of cases of Roux-en-Y retention syndrome was 0, 6 and 0, respectively. There were significant differences among the three groups (Fisher's exact test, P=0.001). Nutritional index: the weight loss were 4.00 (2.00, 5.50) kg, 3.00 (1.25,4.75) kg and 3.00 (1.75,4.25) kg respectively, decreases of hemoglobin level were (5.62±8.20) g/L, (6.63±6.84) g/L and(5.33±7.79) g/L, respectively, decreases of albumin level were 1.00 (-2.50, 7.00) g/L, 3.00 (-1.25, 6.75) g/L and 6.00 (-3.25,7.50) g/L, respectively. There were no significant differences among the three groups (Statistic value were χ 2=1.42, F=0.18 and χ 2=2.43, respectively, P values were 0.492,0.839 and 0.297, respectively). Conclusion:As a digestive tract reconstruction method for radical resection of distal gastric cancer, uncut Roux-en-Y anastomosis can reduce the incidence of Roux-en-Y retention syndrome without increasing the operation risk and affecting the postoperative nutritional status. It is a safe and feasible gastrointestinal tract reconstruction method.
Résumé
Objective:To investigate the effect of uncut Roux-en-Y anastomosis in laparoscopic assisted radical gastrectomy for distal gastric cancer.Methods:The clinical data of 53 patients with distal gastric cancer treated by surgery in Tangshan Union Medical College Hospital from May 2016 to October 2019 were analyzed retrospectively.The operation method was laparoscopic assisted radical gastrectomy for distal gastric cancer.The anastomosis methods were uncut Roux-en-Y anastomosis in 29 cases (uncut group) and Roux-en-Y anastomosis in 24 cases (traditional group). The operation time, digestive tract reconstruction time, the time to flatus, length of hospital stay, incidence of complication and one year followed up results were compared between the two groups.Results:The operation time was (196.0±28.8) min, anastomotic time was (56.1±13.8) min, postoperative exhaust time was (52.5±14.4) h, postoperative hospital stay was (12.5±2.8) d in the uncut group, and (201.0±28.5) min, (57.8±12.9) min, (53.9±14.6) h, (12.0±3.0) d in the traditional group.There was no significant difference between the two groups ( P values were 0.534, 0.664, 0.717 and 0.557, respectively). Postoperative complications: anastomotic leakage was 0(0/29), abdominal bleeding was 3.4% (1/29), alkaline reflux gastritis was 6.9% (2/29) in the uncut group and 4.2% (1/24), 4.2% (1/24) and 4.2% (1/24) in the traditional group respectively.There was no significant difference between the two groups ( P values were 0.453, 1.000 and 1.000, respectively). The incidence of Roux-en-Y stasis syndrome was 0 (0/29) in the uncut group and 25.0% (6/24) in the traditional group.There was significant difference between the two groups ( P=0.006). One case in the uncut group was found recanalization 8 months after operation, the patient underwent reoperation, the method of anastomosis was changed to traditional Roux-en-Y anastomosis.The patient′s symptoms of reflux and hearburn improved significantly after operation. Conclusion:As a digestive tract reconstruction method for radical gastrectomy of distal gastric cancer, uncut Roux-en-Y anastomosis is safe and feasible, and can avoid Roux-en-Y stasis syndrome.