Clinical observation of laparoscopic total gastrectomy and interposition jejunal gastrectomy

doi:10.3877/cma.j.issn.1674-3946.2025.01.010.

Abstract

Abstract:

Objective

To observe the effects of laparoscopic total gastrectomy and interposition jejunal replacement on postoperative nutritional status and gallbladder empties in patients with gastric cancer.

Methods

The clinical data of 116 patients with laparoscopic total gastrectomy from January 2016 to March 2021 were retrospectively analyzed， and divided into the reference group （n=58 cases， digestive tract reconstruction by Roux-en-Y anastomosis） and the study group （n=58 cases， digestive tract reconstruction by interposition jejunum replacement） according to the method of digestive tract reconstruction.SPSS 25.0 software was used to analyze the data.Intraoperative blood loss， digestive tract reconstruction time， intestinal function recovery time and feeding recovery time were described as（x ± s）.Paired sample t test was used for intra-group comparison， and independent sample t test was used for inter-group comparison.The statistical data of complications were shown as［ cases （%）］ and χ² test was performed.P＜0.05 was considered statistically significant.

Results

Serum albumin （ALB）， hemoglobin （HB） and total protein （TP） levels， fasting gallbladder volume （FV）， residual gallbladder volume （RV） and residual gallbladder index （RF） after fat meal were significantly decreased in 2 groups 1 month after surgery， and gallbladder emptier volume （EV） and gallbladder emptier rate （EF） were significantly increased （P＜0.05）.FV， RV and RF in study group were significantly lower than those in reference group， serum ALB， HB， TP， EV and EF were significantly higher than those in reference group （P＜0.05）.The incidence of perioperative and postoperative complications in the study group was significantly lower than that in the reference group （P＜0.05）.

Conclusion

It is safe and feasible to replace the stomach with jejunum after laparoscopic total gastrectomy， which can improve the nutritional status of patients and promote gallbladder empelation.

Key words: Stomach Neoplasms, Laparoscopes, Gastrectomy, Anastomosis, Roux-en-Y

Jia Ren, Shenghui Ma, Xin Wang, Xiuxia Shi, Shuyun Cai. Clinical observation of laparoscopic total gastrectomy and interposition jejunal gastrectomy[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2025, 19(01): 31-34.

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URL: https://zhpwkssxzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-3946.2025.01.010.

https://zhpwkssxzz.cma-cmc.com.cn/EN/Y2025/V19/I01/31

Figures/Tables 6

组别	例数	性别（例）男/女	年龄（岁， $\overset{ˉ}{x}$ ±s）	BMI（kg/m²， $\overset{ˉ}{x}$ ±s）	TNM分期（例）Ⅱ期/Ⅲ	分化程度（例）期中/高
研究组	58	34/24	58.4±6.4	18.3±2.1	24/34	26/32
对照组	58	27/31	56.5±6.4	18.6±2.0	22/36	21/37
t/χ²值		1.694	1.626	0.926	0.144	0.894
P值		0.193	0.107	0.356	0.704	0.344

组别	例数	性别（例）男/女	年龄（岁， $\overset{ˉ}{x}$ ±s）	BMI（kg/m²， $\overset{ˉ}{x}$ ±s）	TNM分期（例）Ⅱ期/Ⅲ	分化程度（例）期中/高
研究组	58	34/24	58.4±6.4	18.3±2.1	24/34	26/32
对照组	58	27/31	56.5±6.4	18.6±2.0	22/36	21/37
t/χ²值		1.694	1.626	0.926	0.144	0.894
P值		0.193	0.107	0.356	0.704	0.344

组别	例数	术中出血量（ml）	消化道重建时间（min）	肠功能恢复时间（d）
研究组	58	258.3±46.0	48.9±6.3	3.5±0.6
对照组	58	264.5±48.3	51.2±6.8	3.6±0.7
t值		0.702	1.840	1.169
P值		0.484	0.068	0.245
组别	例数	恢复进食时间（d）	首次排气时间（h）	住院时间（d）
研究组	58	5.0±0.8	35.3±5.4	8.7±1.3
对照组	58	5.2±0.9	40.1±6.7	10.5±1.4
t值		1.597	4.301	7.298
P值		0.113	0.001	0.001

组别	例数	时间	ALB	HB	TP
研究组	58	术前	52.3±8.6	119.6±18.4	65.3±9.6
研究组	58	术后1个月	46.2±7.3^ab	114.4±16.8^ab	60.3±8.8^ab
对照组	58	术前	51.3±8.8	118.3±18.3	63.3±9.2
对照组	58	术后1个月	42.9±7.0^a	107.8±16.6^a	56.8±8.3^a

组别	例数	时间	FV（ml）	RV（ml）
研究组	58	术前	29.2±3.7	16.2±2.5
研究组	58	术后1个月	22.2±2.6^ab	9.3±1.5^ab
对照组	58	术前	28.4±3.2	15.3±2.8
对照组	58	术后1个月	24.8±2.2^a	12.3±1.7^a
组别	例数	EV（ml）	RF	EF（%）
研究组	58	12.9±2.5	0.6±0.1	0.4±0.1
研究组	58	15.5±2.7^ab	0.4±0.1^ab	0.6±0.1^ab
对照组	58	11.9±2.9	0.6±0.1	0.4±0.1
对照组	58	13.1±2.7^a	0.5±0.1^a	0.5±0.1^a

组别	例数	出血	腹腔感染	肺不张	切口感染	吻合口漏	合计
研究组	58	2（3.4）	0（0.0）	1（1.7）	2（3.4）	1（1.7）	6（10.3）
对照组	58	6（10.3）	3（5.2）	2（3.4）	1（1.7）	3（5.2）	15（25.9）
χ²值		-	-	-	-	-	4.710
P值		-	-	-	-	-	0.030

组别	例数	倾倒综合征	反流性食管炎	胆囊结石	合计
研究组	58	1（1.7）	0（0.0）	1（1.7）	2（3.4）
对照组	58	3（5.2）	3（5.2）	2（3.4）	8（13.8）
χ²值		-	-	-	3.940
P值		-	-	-	0.047

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