Abstract:

Objective

To explore the effects of different anastomotic methods of total laparoscopic distal subtotal gastrectomy on gastric function recovery and complication rate in patients with gastric cancer.

Methods

The clinical data of 106 patients with distal gastric cancer from January 2019 to January 2021 were retrospectively analyzed.According to different anastomosis methods， they were divided into Bi's group（underwent distal subtotal gastrectomy and Bi's anastomosis） and triangle group （underwent distal subtotal gastrectomy and triangular anastomosis）.Confounding factors were excluded according to propensity matching score （caliper value 0.02）.There were 53 patients in each group.SPSS 22.0 software was used to analyze the data.Measurement data such as perioperative indexes and gastric function indexes were expressed in the form of （x± s）， and independent sample t test was performed between groups.The complication rate and other statistical data were χ² test.P＜0.05 was considered statistically significant.

Results

The operative time， intraoperative blood loss， time to get out of bed and time to first feed fluid in triangle group were significantly lower than those in Bi Ⅰ group （P＜0.05）， while the length of hospital stay and number of lymph node dissection were not significantly different between the two groups （P＞0.05）.The complication rate of triangle group was significantly lower than that of Bi Ⅰ group （P＜0.05）.Gastrin （GAS） in the two groups was significantly decreased 1 day after surgery （P＜0.05）， and significantly increased 7 days after surgery （P＜0.05）， and the recovery of the triangle group was significantly better than that of the Bi's group（P＜0.05）， and the gastric empting rate and the number of stomach peristalsis in the two groups were significantly increased 90 days after surgery （P＜0.05）.The triangulation group was significantly higher than that of Bi's group （P＜0.05）.Follow-up was 3 years and the median follow-up was 27 months.There was no significant difference in progression-free survival （PFS） between the two groups （Log-Rankχ²=0.884， P=0.347），and overall survival （OS） between the two groups （Log-Rankχ²=1.182， P=0.279）.

Conclusion

Distal subtotal gastrectomy combined with Bidi's or triangular anastomosis can effectively treat distal gastric cancer and restore gastric function.Compared with Bidi's operation， triangular anastomosis has significant advantages in improving gastric function and reducing surgical complications， and is worthy of application.

Key words: Stomach Neoplasms, Laparoscopes, Gastrectomy, Billroth I Anastomosis, Delta-Shaped Anastomosis, Postoperative Complications