Comparison of different reconstruction methods of alimentary canal after laparoscopic total gastrectomy on gallbladder function and occurrence of gallstones

doi:10.3877/cma.j.issn.1674-3946.2022.02.020

Abstract

Abstract:

Objective

To investigate the effect of different digestive tract reconstruction in patients with laparoscopic total gastrectomy.

Methods

The clinical data of 76 patients who underwent total gastrectomy for gastric cancer from January 2019 to November 2020 were retrospectively selected，and divided into two groups according to the different reconstruction methods of digestive tract. 40 patients in the double-channel jejunal interposition group and 36 patients in the Roux-en-Y esophagojejunal Roux-en-Y anastomosis group received double-channel jejunal interposition. Statistical software SPSS 22.0 was used for data analysis. Perioperative indicators，intestinal microflora，gallbladder contraction function and other measurement data were represented by（

x ˉ

±s），and independent t test was performed between groups. Statistical data such as postoperative complications were compared by χ² test and rank sum test. P?0.05 was statistically significant.

Results

All patients successfully completed the operation，and no patients were converted to open surgery. The first postoperative exhaust time in the two-channel group was shorter than that in the Roux-en-Y group（P?0.05）. Here are the results of 3 and 6 months after surgery：Bifidobacteria and lactobacillus were increased in the two-channel group，enterococcus and Escherichia coli were decreased，while enterococcus and Escherichia coli were increased（P?0.05）；In roux-en-Y group，bifidobacteria and lactobacillus were decreased，while enterococcus and Escherichia coli were increased（P?0.05）；The gallbladder volume and serum cholecystokinin（CCK）in the two-channel group were lower than those in the ROUX-en-Y group，and the gallbladder emptation rate was higher than that in the RouX-en-Y group（P<0.05）；The incidence of gallstones and complications in the dual-channel group was lower than that in the Roux-en-Y group（χ²=3.985，P=0.046；χ²=4.504，P=0.034）.

Conclusion

Double channel jejunal interposition in laparoscopic total gastrectomy can effectively promote the recovery of intestinal function and maintain the balance of intestinal flora，which is beneficial to the recovery of gallbladder systolic function and reduce the occurrence of gallbladder stones.

Key words: Gastrectomy, Laparoscopes, Double channel jejunal interposition, Intestinal flora, Gallbladder systolic function, Comparative effectiveness research

Junfei Zhang, Xinmei Song, Wenjie Xie, Xi Yang, Shuai Niu. Comparison of different reconstruction methods of alimentary canal after laparoscopic total gastrectomy on gallbladder function and occurrence of gallstones[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2022, 16(02): 192-195.

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URL: https://zhpwkssxzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-3946.2022.02.020

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References 15

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组别	例	性别	年龄（岁）	BMI（kg/m²）	肿瘤直径（cm）	肿瘤部位	分化程度	TNM分期
组别	例	男/女	年龄（岁）	BMI（kg/m²）	肿瘤直径（cm）	贲门/胃体/胃窦	高/中/低	Ⅱ/Ⅲ/Ⅳ
双通道组	40	23/17	59.6±2.4	23.2±1.9	5.2±0.7	9/25/6	18/14/8	13/21/6
Roux-en-Y组	36	21/15	60.1±2.7	24.1±2.3	4.9±0.9	11/20/5	15/14/7	12/19/5
χ²/t/Z		0.005	-0.855	-1.867	1.631	-0.657	-0.191	-0.121
P		0.941	0.395	0.066	0.107	0.511	0.849	0.904

组别	例	性别	年龄（岁）	BMI（kg/m²）	肿瘤直径（cm）	肿瘤部位	分化程度	TNM分期
组别	例	男/女	年龄（岁）	BMI（kg/m²）	肿瘤直径（cm）	贲门/胃体/胃窦	高/中/低	Ⅱ/Ⅲ/Ⅳ
双通道组	40	23/17	59.6±2.4	23.2±1.9	5.2±0.7	9/25/6	18/14/8	13/21/6
Roux-en-Y组	36	21/15	60.1±2.7	24.1±2.3	4.9±0.9	11/20/5	15/14/7	12/19/5
χ²/t/Z		0.005	-0.855	-1.867	1.631	-0.657	-0.191	-0.121
P		0.941	0.395	0.066	0.107	0.511	0.849	0.904

组别	例	重建时间（min）	术中出血量（ml）	淋巴结清扫数目（枚）	排气时间（d）
双通道组	40	47.5±5.3	123.6±23.2	24.6±3.7	3.2±0.5
Roux-en-Y组	36	46.9±5.2	125.3±22.6	24.4±3.8	3.4±0.3
t		0.497	-0.323	0.232	2.085
P		0.621	0.748	0.817	0.041

组别	例	重建时间（min）	术中出血量（ml）	淋巴结清扫数目（枚）	排气时间（d）
双通道组	40	47.5±5.3	123.6±23.2	24.6±3.7	3.2±0.5
Roux-en-Y组	36	46.9±5.2	125.3±22.6	24.4±3.8	3.4±0.3
t		0.497	-0.323	0.232	2.085
P		0.621	0.748	0.817	0.041

组别	例	时间	双歧杆菌	乳酸杆菌	肠球菌	大肠杆菌
双通道组	40	术前	8.0±0.7^a	7.9±0.6^a	9.5±0.4^a	8.9±0.7^a
		T3	9.2±0.6^b	9.7±0.6^b	8.3±0.3^b	7.4±0.3^b
		T6	9.4±0.3^b	9.8±0.4^b	8.2±0.5^b	7.5±0.2^b
Roux-en-Y组	36	术前	7.9±0.9^a	7.8±0.7^a	9.4±0.7^a	8.8±0.7^a
		T3	7.3±0.8	7.5±0.5	9.8±0.9	9.1±0.4
		T6	7.1±0.6	7.5±0.2	9.7±0.3	9.2±0.1

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