Clinical evaluation of three digestive tract reconstruction methods after radical resection of adenocarcinoma of esophagogastric junction

doi:10.3877/cma.j.issn.1674-3946.2022.05.021

Abstract

Abstract:

Objective

To evaluate the clinical effect of three digestive tract reconstruction methods after radical resection of adenocarcinoma of esophagogastric junction（AEG）.

Methods

The clinical data of 60 patients with AEG admitted to our hospital from January 2018 to December 2020 were prospectively included. The patients were randomly divided into group A，group B and group C，each of 20 cases. Proximal gastrectomy was performed in all three groups. Group A was treated with esophagogastric anastomosis，group B was treated with tubular gastric anastomosis，and group C was treated with double channel anastomosis. The data were processed by SPSS 22.0.The perioperative indexes and postoperative nutritional status indexes were expressed by（

x ˉ

±s）. The comparison between multiple groups was analyzed by One-Way ANOVA，the comparison between the two groups was performed by LSD-t test，and the comparison within the group was performed by paired t test；Postoperative complications were counted by χ² test. P<0.05 was statistically significant.

Results

The operation time and anastomosis time in groups A and B were significantly lower than those in group C（P<0.05）. The incidence of postoperative reflux esophagitis in groups B and C was significantly lower than that in group A（10.0% vs. 5.0% vs. 40.0%，P<0.05）. The nutritional indexes of serum hemoglobin（Hb），total protein（TP），albumin（ALB）and BMI at 6 months after operation were significantly lower than those before operation（P<0.05），and the nutritional indexes in group C were significantly higher than those in groups A and B（P<0.05）.

Conclusion

AEG radical gastrectomy with tubular gastric anastomosis and double-channel anastomosis has more significant anti-reflux effect. Although double-channel anastomosis prolongs the operation time，it does not increase the risk of postoperative anastomotic stenosis，and is more conducive to postoperative nutritional recovery of patients，with more obvious advantages.

Key words: Adenocarcinoma of esophagogastric junction, Digestive tract reconstruction, Proximal gastrectomy, Anastomosis，surgical

Qingtao Zou, Hongzhen Zhang, Zuowen Yin, Jun Yu, Peng Zhang. Clinical evaluation of three digestive tract reconstruction methods after radical resection of adenocarcinoma of esophagogastric junction[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2022, 16(05): 545-548.

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References 15

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组别	例	性别	年龄 (岁)	BMI (kg/m²)	基础疾病
组别	例	男/女	年龄 (岁)	BMI (kg/m²)	有/无
A组	20	14/6	61.3±8.8	23.7±2.4	8/12
B组	20	15/5	60.8±9.5	22.5±2.7	9/11
C组	20	13/7	62.1±8.3	23.3±2.5	7/13
χ²/F/Z		0.476	0.109	1.161	0.417
P		0.788	0.897	0.321	0.812
组别	例	肿瘤长径 (cm）	Siewert分型	TNM分期	分化程度
组别	例	肿瘤长径 (cm）	Ⅱ/Ⅲ	Ⅰ/Ⅱ	高/中/低
A组	20	3.0±1.3	13/7	9/11	3/10/7
B组	20	3.3±1.1	11/9	11/9	4/10/6
C组	20	3.1±1.2	14/6	10/10	3/11/6
χ²/F/Z		0.323	1.005	0.400	0.206
P		0.726	0.605	0.819	0.902

组别	例	性别	年龄 (岁)	BMI (kg/m²)	基础疾病
组别	例	男/女	年龄 (岁)	BMI (kg/m²)	有/无
A组	20	14/6	61.3±8.8	23.7±2.4	8/12
B组	20	15/5	60.8±9.5	22.5±2.7	9/11
C组	20	13/7	62.1±8.3	23.3±2.5	7/13
χ²/F/Z		0.476	0.109	1.161	0.417
P		0.788	0.897	0.321	0.812
组别	例	肿瘤长径 (cm）	Siewert分型	TNM分期	分化程度
组别	例	肿瘤长径 (cm）	Ⅱ/Ⅲ	Ⅰ/Ⅱ	高/中/低
A组	20	3.0±1.3	13/7	9/11	3/10/7
B组	20	3.3±1.1	11/9	11/9	4/10/6
C组	20	3.1±1.2	14/6	10/10	3/11/6
χ²/F/Z		0.323	1.005	0.400	0.206
P		0.726	0.605	0.819	0.902

组别	例	手术时间 (min)	术中出血量 (ml）	淋巴结清扫数目 (枚）
A组	20	217.1±18.4^a	189.1±35.3	22.1±2.5
B组	20	225.6±20.1^a	191.2±36.8	21.3±2.7
C组	20	238.3±23.5	193.6±26.3	22.7±3.0
F		5.275	0.092	1.313
P		0.008	0.912	0.277
组别	例	重建吻合时间 (min）	术后排气时间 (d）	术后住院时间 (d）
A组	20	24.4±7.2^a	3.5±1.5	12.6±3.0
B组	20	28.1±8.5^a	3.3±1.3	11.2±2.7
C组	20	33.2±9.3	3.1±1.1	10.8±2.8
F		7.161	0.466	2.221
P		0.002	0.630	0.118

组别	例	手术时间 (min)	术中出血量 (ml）	淋巴结清扫数目 (枚）
A组	20	217.1±18.4^a	189.1±35.3	22.1±2.5
B组	20	225.6±20.1^a	191.2±36.8	21.3±2.7
C组	20	238.3±23.5	193.6±26.3	22.7±3.0
F		5.275	0.092	1.313
P		0.008	0.912	0.277
组别	例	重建吻合时间 (min）	术后排气时间 (d）	术后住院时间 (d）
A组	20	24.4±7.2^a	3.5±1.5	12.6±3.0
B组	20	28.1±8.5^a	3.3±1.3	11.2±2.7
C组	20	33.2±9.3	3.1±1.1	10.8±2.8
F		7.161	0.466	2.221
P		0.002	0.630	0.118

组别	例	切口感染	吻合口漏	吻合口出血	吻合口狭窄	肠梗阻	反流性食管炎
A组	20	1(5.0）	0(0.0）	1(5.0）	1(5.0）	1(5.0）	8(40.0）
B组	20	1(5.0）	3(15.0）	0(0.0）	3(15.0）	1(5.0）	2(10.0）^a
C组	20	1(5.0）	2(10.0）	1(5.0）	0(0.0）	0(0.0）	1(5.0）^a
χ²		0.000	3.055	1.034	3.750	1.034	9.573
P		1.000	0.217	0.596	0.153	0.596	0.008

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