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 assess the influence of different digestive tract reconstruction on the blood glucose of gastric antral cancer patients with type 2 diabetes. Methods The clinical data of 51 cases of gastric antral cancer with type 2 diabetes treated radical surgery in this hospital from January 2006 to January 2012 were analyzed retrospectively. The patients were divided into three groups according to the different digestive tract reconstruction methods：BillrothⅠ anastomosis group （n=14）， BillrothⅡ anastomosis group （n=28）， and Roux-en-Y anastomosis group （n=9）. The indexes were analyzed and compared among three groups：① The levels of fast blood glucose （FBG） and 2h postprandial blood glucose （PG2h） were detected before operation and on 1 month and 6 months after the operation；② The level of glycated hemoglobin （HbA1c） was detected before operation and 6 months after the operation；③ The diabetes control was observed. Results The FBG and PG2h levels in the BillrothⅠ anastomosis group detected on 1 month and 6 months after the operation were not statistically different from those detected before the operation （P＞0.05）. The FBG and PG2h levels in the BillrothⅡanastomosis group and Roux-en-Y anastomosis group detected on 1 month and 6 months after the operation were significantly lower than those before the operation respectively （P＜0.05）. The FBG and PG2h levels in the BillrothⅡ anastomosis group detected on 1 month and 6 months after the operation were not statistically different from those in the Roux-en-Y anastomosis group respectively （P＞0.05）， but which were markedly lower than those in the BillrothⅠ anastomosis group， the differences were statistically significant （P＜0.05）. The HbA1c levels in the BillrothⅠ anastomosis group detected before the operation and on 6 months after the operation were not statistically different from each other （P＞0.05）. The HbA1c levels in the BillrothⅡ anastomosis group and Roux-en-Y anastomosis group detected on 6 months after the operation were markedly lower than those before the operation and the difference was statistically significant （P＜0.05）. On 6 months after the operation， the HbA1c levels in the BillrothⅡanastomosis group and Roux-en-Y anastomosis group were markedly lower than those in the BillrothⅠ anastomosis group and the differences were statistically significant （P＜0.05）；the HbA1c level was not statistically different between the BillrothⅡ anastomosis group and the Roux-en-Y anastomosis group （P＞0.05）. The total curative effects in the BillrothⅡ anastomosis and Roux-en-Y anastomosis groups were significantly better than those in the BillrothⅠ anastomosis group （P＜0.05）. Conclusion According to our limited clinical data， BillrothⅡ anastomosis and Roux-en-Y anastomosis for gastric antral cancer patients with type 2 diabetes may be the best surgical approach.
Objective To summarize recent progress of three types of basic digestive tract reconstruction methods after distal gastrectomy for gastric cancer. Methods Recent domestic and international literatures about three types of basic digestive tract reconstruction methods after distal gastrectomy for gastric cancer were collected and analyzed. Results Of the three types of basic digestive tract reconstruction methods, BillrothⅠanastomosis had the most obvious advantage compared to BillrothⅡanastomosis and Roux-en Y anastomosis, but it was limited by tumor' size. The performance of BillrothⅡanastomosis was relatively easier but its complication risk was higher. Roux-en-Y anastomosis was superior in body weight control and treatment of type 2 diabetes mellitus, and had a wider indication than the other two types of methods. The modified uncut Roux-en-Y anastomosis was easier to perform under laparoscopic surgery. Conclusions Each method of the three types of basic digestive tract reconstruction methods after distal gastrectomy has its own superiority and indication. Therefore, the choice of digestive tract reconstruction method after distal gastrectomy should be case by case.
目的 评价国产吻合器和闭合器在食管癌消化道重建术中的应用价值。 方法 回顾性分析2005年3月-2008年4月期间收治的387例食管癌手术患者的临床资料，根据不同消化道重建方式分为手工吻合组（n=172）和器械吻合组（n=215），对两组患者吻合时间、术中出血量及术后并发症发生情况进行对比分析。 结果 全组无手术死亡。器械吻合组和手工吻合组术中出血量的差别无统计学意义（Pgt;0.05），但前者的吻合时间、住院时间均少于后者（Plt;0.05）。手工吻合组术后吻合口出血多于器械吻合组（5.2%比1.4%，Plt;0.05），发生吻合口漏亦多于器械吻合组（6.4%比2.8%，Plt;0.05）。随访1.5～2年，排除失访患者后，器械吻合组吻合口狭窄发生率低于手工吻合组（4.6%比10.3%，Plt;0.05）。 结论 国产吻合器与和缝合器用于食管癌的消化道重建安全有效，值得在基层医院推广应用。
Objective To systematically review perioperative safety and middle-term and long-term complications of Roux-en-Y anastomosis and Billroth-Ⅰ anastomosis after distal subtotal gastrectomy by a meta-analysis. Methods Literatures about Roux-en-Y and Billroth-Ⅰ anastomoses after distal subtotal gastrectomy in Embase, PubMed, MedLine, and the Cochrane Library databases were searched. Retrieval time was from December 1, 2015 to March 1, 2016. According to the inclusion and exclusion criteria, two reviewers independently screened literatures, extracted data, and evaluated the qualities of the included studies. Then meta-analysis was performed using Review Manager Version 5.1 software. Results Five randomized controlled trials (RCTs) were finally included involving 600 patients, of which 302 patients were underwent Roux-en-Y anasomosis, 298 patients were underwent Billroth-Ⅰ anasomosis. The results of meta-analysis showed that the Billroth-Ⅰ anastomosis operation had more advantages in the operative time 〔WMD: 38.95; 95%CI: (19.86, 58.04);P<0.000 1〕 and the intraoperative bleeding 〔WMD: 34.85; 95%CI: (2.13, 67.56);P=0.04〕. However, the Roux-en-Y anastomosis had more significant effects in the prevention of bile reflux 〔OR: 0.03; 95%CI: (0.01, 0.11);P<0.000 01〕 and the residual gastritis 〔OR: 0.37; 95%CI: (0.25, 0.54);P<0.000 01〕. There were no differences in the hospital stay 〔WMD: 2.96; 95%CI: (–0.00, 5.93);P=0.05〕, anastomotic leakage 〔OR: 0.43; 95%CI: (0.11, 1.68);P=0.23〕, anastomotic stricture 〔OR: 1.84; 95%CI: (0.61, 5.53);P=0.27〕, reflux esophagitis〔OR: 0.63; 95%CI: (0.28, 1.44);P=0.27〕, and delayed gastric emptying 〔OR: 1.24; 95%CI: (0.46, 3.30);P=0.67〕 between the Roux-en-Y anastomosis and Billroth-Ⅰ anastomosis. Conclusions Billroth- I anastomosis and Roux-en-Y anastomosis have their own advantages and disadvantages, in term of safety of Billroth- I anastomosis is better, but it’s quality of life is worse as compared with Roux-en-Y anastomosis. However, more high-quality, well-designed, adequate RCTs data are needed to validate.
Objective To summarize the research progress of digestive tract reconstruction after total gastrectomy in gastric cancer. Methods The domestic and international published literatures about digestive tract reconstruction after total gastrectomy in gastric cancer were retrieved and reviewed. Results More and more attention had been paid to the postoperative quality of life after total gastrectomy in gastric cancer， and the most related factor for postoperative quality of life was the type of digestive tract reconstruction. The pouch reconstruction and preservation of enteric myoneural continuity showed beneficial effects on clinical outcomes. Current opinion considered the pouch reconstruction might be safe and effective， and was able to improve the postoperative quality of life of patients with gastric cancer. However， the preservation of duodenal pathway didn’t show significant benefits. Conclusion The optimal digestive tract reconstruction after total gastrectomy is still debating， in order to resolve the controversies， needs more in-depth fundamental researches and more high-quality randomized controlled trials.