ObjectiveTo evaluate the effect of glutamineenhanced enteral nutritional support on elder patients after total gastrectomy. MethodsA total of eightyfour cases of elder patients receiving total gastrectomy were included in this study from February 2008 to August 2010. The patients were randomly divided into three groups: glutamineenhanced enteral nutrition (Gln) group, enteral nutrition (EN) group and parenteral nutrition (PN) group. The complications and hospital stay after operation were compared, and the levels of serum total protein, albumin, proalbumin， and transferrin of patients were measured before operation, on 2 d and 10 d after operation, respectively. Furthermore, the percentage of CD4 and CD8 T cells, CD4/CD8 ratio， and the levels of serum IgM and IgG of patients in peripheral blood before and after operation were detected. ResultsNutritional therapy was successfully performed in patients of three groups. The anal exhaust time and hospital stay after operation of patients in Gln group and EN group were significantly lower than those in PN group (Plt;0.05). The difference of postoperative complications and digestive tract symptoms of patients in three groups was not obvious (Plt;0.05). Anastomotic fistula occurred in one patient of PN group on 6 d after operation and was cured by conservative treatment for 54 d. The difference of total protein, albumin, proalbumin, and transferrin levels of patients in three groups before operation was not significant (Pgt;0.05), and these indexes fell dramatically on 2 d after operation and lower than before operation (Plt;0.05), although the intergroup difference was not statistically significant (Pgt;0.05). On 10 d after operation, all indexes recovered in different extent, while those data in Gln group and EN group were significantly higher than those on 2 d after operation (Plt;0.05). The levels of total protein, albumin, and proalbumin of patients in Gln group and EN group were markedly higher than those in PN group (Plt;0.05), although there was no difference between the former groups (Pgt;0.05). The difference of several immunological parameters of patients in three groups before operation was not significant (Pgt;0.05). On 10 d after operation, the percentage of CD4 and CD8 T cells, CD4/CD8 ratio, and the levels of serum IgM and IgG of patients in Gln group returned and even exceeded the preoperative results, which were significantly higher than those in EN group and PN group other than IgM (Plt;0.05). The postoperative results of all parameters except IgG in EN group were significantly lower than preoperative results in patients of EN group and PN group (Plt;0.05). ConclusionsIt is safe and feasible to elder patients who had received total gastrectomy and perioperative glutamine-enhanced nutritional support, which can improve nutrition and immune status, promote the recovery and reduce the duration of hospital stay, and nutritiional support after total gastrectomy is one of the optimal choices for these patients.
Objective To explore the pain after discharged in patients with radical total gastrectomy under painless ward management, and to analyze the causes of pain in order to guide the treatment strategy after discharge. Methods Retrospective analysis was performed on the pain data of 82 patients who underwent radical total gastrectomy in The First Affiliated Hospital of Air Force Military Medical University from December 2015 to April 2017, and the situation of pain was followed-up at 2 weeks, 1 month, 2 months, and 3 months after discharged. Results Mild pain occurred in 25 patients at the 2 weeks after discharged; mild pain occurred in 38 patients and moderate pain occurred in7 patients at the first month after discharged; mild pain occurred in 31 patients and moderate pain occurred in 4 patients at the second month after discharged; 19 patients had mild pain at the third month after discharged. There was no significant difference in pain scores between male patients and female patients, <60 years old patients and ≥60 years old patients, patients’ operative time<180 min and patients’ operative time ≥180 min, patients’ intraoperative blood loss<200 mL and patients’ intraoperative blood loss ≥200 mL at the all time points, including the second week, the first, the second, and the third month after discharge ( P>0.05). Conclusion Painless ward management can effectively control the degree of pain in discharged patients who underwent radical total gastrectomy.
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.
Objective To evaluate whether jejunal interposition pouch (JIP) reconstruction is an ideal procedure of digestive tract reconstruction after total gastrectomy. Methods Ninetyfour patients after total gastrectomy had randomly divided into two groups, JIP group 42 cases and RouxenY pouch (RYP) group 52 cases. The gastrointestinal function improvement in body weight and nutritional parameters (serum albumin, hemoglobin level, and serum protein) were compared 1 year after surgery for the two groups. Results The nutritional condition of JIP group and RYP group after operation had improved (P＜0.01); and the condition of JIP group with fewer symptom problems demonstrated much more better than standard RYP group （P＜0.01）. Conclusion JIP that could obtain partly compensatory function after total gastrectomy is an ideal reconstruction.
Objective To evaluate the clinical application of modified Orr Roux-en-Y type digestive tract reconstruction. Methods Thirty-eight patients with gastric cancer were randomly classified into modified group （accepted modified Orr Roux-en-Y type digestive tract reconstruction, 18 cases） and ρ group （accepted ρ type esophagojejunostomy, 20 cases） according to the date of operation. Operative time, blood loss in operation, complications after operation, emptying time of pouch, and change of body weight before and 3 months after operation were compared between two groups. Results Compared with the ρ group 〔(283±35) min〕, the operative time of modified group 〔(229±18) min〕 was significantly shorter （Plt;0.05）. The holo-empyting time of pouch in modified group 〔(35.7±4.9) min〕 was longer than that in ρ group 〔(3.0±0.5) min〕, Plt;0.01. Blood loss in operation, complications after operation, and the body weight change had no statistical difference between two groups （Pgt;0.05）. Conclusion Modified Orr Roux-en-Y type reconstruction with a pouch function is useful in clinical application， which is not only easy to operate, but also can reduce the operative time and the complications.
世界首例成功的全胃切除及消化道重建术（结肠前食管空肠端侧吻合术）1897年由德国人Schlatter完成； 随后Briigham对重建的术式做出了最早的探索，这一食管十二指肠吻合术也是最早的保留十二指肠食物通道功能的术式（Billroth Ⅰ）； 1903年Moynihan提出应加行空肠输入-输出袢之间的侧侧吻合（Braun吻合）； 1947年Orr提出的Roux-en-Y术式是最经典的不保留十二指肠食物通道功能的术式，以它为基础的术式（Billroth Ⅱ）在全胃切除术后的消化道重建中占有主要地位［1］。......
Objective To explore the feasibility of arch-preserved jejunum in total gastrectomy with Roux-en-Y esophagojejunostomy for adenocarcinoma of esophagogastric junction （AEG） and upper-middle gastric cancer. Methods Clinical data of 13 patients who underwent total gastrectomy with Roux-en-Y esophagojejunostomy with usage of arch-preserved jejunum to resolve the anastomosis tension problem in our hospital from Dec. 2012 to Apr. 2013 were analyzedretrospectively， and surgical experience was summarized. Results The maximal and actual extended lengths were （7.75±1.75） cm （4-10 cm） and （5.95±1.82） cm （3-9 cm） respectively， with the utilization percentage of （77.91±16.60）% （50.0%-100.0%）. These patients hadn’t suffered postoperative mortality and severe complications， such as anastomosis leakage， stenosis， hemorrhage， and so on. Besides， there were 1 case complicated with postoperative acute urinary retention and another 1 case complicated with infra-hepatic space abscess and peritoneal infection. Conclusion Arch-preserved jejunum is a practical surgical technique to handle with the anastomosis tension of esophagojejunostomy in total gastrectomy for AEG and upper-middle gastric cancer.
Objective To evaluate the effect of total gastrectomy (TG) and proximal gastrectomy (PG) for the treatment of advanced esophagogastric junction cancer. Methods Clinical data of 273 cases of advanced esophagogastric junction cancer who underwent TG and PG in our hospital from Jan. 2004 to Dec. 2010 were reviewed for retrospective analysis. Operation related indexes, 3-year cumulative survival rate, and 5-year cumulative survival rate were compared and evaluated. Results There was no significant difference between TG group and PG group in intraoperative blood loss, operation time, and hospital stay(P > 0.05), but the number of dissected lymph nodes in TG group was obviously more than those of PG group, and the difference was statistically significant(P=0.000). The postoperative complication rates were 10.3%(12/117)in TG group and 21.8%(34/156) in PG group respectively, which was lower in TG group(χ2=6.353, P < 0.05). The 3-year and 5-year cumulative survival rates of TG group were 58.9% and 34.2%, of PG group were 43.4% and 23.6% respectively, and the 3-year and 5-year cumulative survival rates were all lower in PG group(χ2=5.894, P < 0.05;χ2=5.582, P < 0.05). For patients in stage pT4, pN2, and TNMⅢ, whose tumor size were bigger than 3.0 cm, and patients who had accept chemotherapy, the 3-and 5-year cumulative survival rates of TG group were significantly higher than those of PG group(P < 0.05). However, for patients in stage pT2, pT3, pN0, pN1, pN3, TNMⅠ, TNMⅡ, TNMⅣ, whose tumor size were smaller than 3.0 cm, who had not accept chemotherapy, and patients of any pathological type, there was no statistically significant difference between the 2 groups in 3-year and 5-year cumulative survival rates(P > 0.05). Conclusion For the patients who suffered from advanced esophagogastric junction cancer, TG can improve long-term survival rate, and it can significantly reduce the incidence of postoperative complications and improve postoperative quality of life.