Analysis of laparoscopy-assisted radical gastrectomy in digestive tract reconstruction for distal gastric cancer
ZHANG Mingjin;WANG Shichen;LI Yeyun;HE Junfeng;CHEN Shangchuan;LIU Peng;LI Yang;ZHAO Chenggong;Department of General Surgery,the 105 Hospital of People's Liberation Army;
Objective To compare the different ways of reconstruction of digestive tract in laparoscopy-assisted radical gastrectomy for distal gastric cancer. Method 51 patients with distal gastric cancer who were treated with laparoscopy-assisted radical gastrectomy were retrospectively analyzed. These patients were grouped by respective digestive tract reconstruction as group A(n=10), group B(n=8), group C(n=17), and group D(n=16), with Billroth I anastomosis, Billroth II anastomosis, Roux-En-Y anastomosis, and un-Cut Roux-En-Y anastomosis administered, respectively. The intraoperative and postoperative indicators, complications and prognosis were compared. Result The overall average operative time of 51 patients with gastric cancer was(198.6±20.0) minutes, and the average time for anastomosis was(51.7±11.4)minutes. The time of operation and anastomosis in group A and B were significantly shorter than those in group C and D(P0.01). There was no significant differences in regard of intraoperative blood loss, number of dissected lymph nodes,time to intestinal exhaust, and time to extubation of the drainage tube as well as the hospital stay among the four groups(P0.05). The main postoperative complications of gastric cancer were anastomotic leakage and infection. Conclusion The four types of laparoscopy-assisted radical gastrectomy for distal gastric cancer are safe and feasible. Each surgical procedure has its own advantages and disadvantages, Billroth I anastomosis is physiologically applicable; while Billroth II anastomosis is better in regard of the anastomotic tension compared with Billroth I; Roux-En-Y anastomosis solves the problem of high tension in anastomosis, and alkaline bile reflux; however, un-Cut Roux-En-Y anastomosis may not only block the movement of jejunal contents, but also preserve the continuity of jejunal muscle electrical conductivity, which helps reduce the occurrence of stasis syndrome, meanwhile the difficulty of surgery is not significantly increased, and the time to anastomosis is not significantly longer, so it could be a relatively better choice.
【CateGory Index】： R735.2