Objective To investigate the effects of esophageal narrow tube gastric anastomosis and traditional distal hemigastric anastomosis on postoperative gastric emptying in patients with advanced Siewert Ⅱ adenocarcinoma of esophagogastric junction(AEG).
Methods A total of 56 patients with advanced Siewert Ⅱ AEG scheduled for surgery were selected and divided into narrow tube gastric anastomosis group(n=26) and distal hemigastric anastomosis group(n=30) according to the anastomosis methods.The operative indexes, postoperative recovery, postoperative complications, pathological findings and nutritional changes before and after operation were compared between the two groups, and 99mTc-DPTA was used to examine the gastric emptying at 2 to 3 months after surgery.
Results There was no significant difference in operation time, intraoperative bleeding, nutrition tube time of duodenum and hospital stay between the two groups(P>0.05).The time of indwelling drainage tube and postoperative fasting in narrow tube gastric anastomosis group were significantly shorter than that in distal hemigastric anastomosis group(P < 0.01).There was no significant difference in postoperative complications, T stage, N stage, TNM stage and tumor differentiation between the two groups(P>0.05), the acid reflux score in narrow tube gastric anastomosis group was significantly lower than that in distal hemigastric anastomosis group(P < 0.01), and the number of cases using acid inhibitors was less than that in distal hemigastric anastomosis group(P < 0.05).There was no significant difference in the levels of serum prealbumin, hemoglobin(HGB) and albumin(ALB) between the two groups before and after operation(P>0.05), the level of HGB and ALB in narrow tube gastric anastomosis group was lower than that before operation(P < 0.05), and the level of HGB in distal hemigastric anastomosis group was significantly lower than that before operation(P < 0.01).The half time of gastric emptying in narrow tube gastric anastomosis group was significantly shorter than that in distal hemigastric anastomosis group(P < 0.01), the 5 min emptying rate, 10 min emptying rate and 20 min emptying rate were higher than those in distal hemigastric anastomosis group(P < 0.05 to P < 0.01), the number of cases with delayed gastric emptying was less than that in distal hemigastric anastomosis group(P < 0.05), and there was no significant difference in 1 h emptying rate and 2 h emptying rate between the two groups(P> 0.05).
Conclusions The gastric emptying of patients with advanced Siewert Ⅱ AEG after esophageal narrow tube gastric anastomosis is significantly faster than that of traditional distal hemigastric anastomosis, which is beneficial to postoperative feeding and reducing postoperative gastroesophageal reflux.
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