Objective To assess the influence of different digestive tract reconstruction on the blood glucose of gastric antral cancer patients with type 2 diabetes. Methods The clinical data of 51 cases of gastric antral cancer with type 2 diabetes treated radical surgery in this hospital from January 2006 to January 2012 were analyzed retrospectively. The patients were divided into three groups according to the different digestive tract reconstruction methods：BillrothⅠ anastomosis group （n=14）， BillrothⅡ anastomosis group （n=28）， and Roux-en-Y anastomosis group （n=9）. The indexes were analyzed and compared among three groups：① The levels of fast blood glucose （FBG） and 2h postprandial blood glucose （PG2h） were detected before operation and on 1 month and 6 months after the operation；② The level of glycated hemoglobin （HbA1c） was detected before operation and 6 months after the operation；③ The diabetes control was observed. Results The FBG and PG2h levels in the BillrothⅠ anastomosis group detected on 1 month and 6 months after the operation were not statistically different from those detected before the operation （P＞0.05）. The FBG and PG2h levels in the BillrothⅡanastomosis group and Roux-en-Y anastomosis group detected on 1 month and 6 months after the operation were significantly lower than those before the operation respectively （P＜0.05）. The FBG and PG2h levels in the BillrothⅡ anastomosis group detected on 1 month and 6 months after the operation were not statistically different from those in the Roux-en-Y anastomosis group respectively （P＞0.05）， but which were markedly lower than those in the BillrothⅠ anastomosis group， the differences were statistically significant （P＜0.05）. The HbA1c levels in the BillrothⅠ anastomosis group detected before the operation and on 6 months after the operation were not statistically different from each other （P＞0.05）. The HbA1c levels in the BillrothⅡ anastomosis group and Roux-en-Y anastomosis group detected on 6 months after the operation were markedly lower than those before the operation and the difference was statistically significant （P＜0.05）. On 6 months after the operation， the HbA1c levels in the BillrothⅡanastomosis group and Roux-en-Y anastomosis group were markedly lower than those in the BillrothⅠ anastomosis group and the differences were statistically significant （P＜0.05）；the HbA1c level was not statistically different between the BillrothⅡ anastomosis group and the Roux-en-Y anastomosis group （P＞0.05）. The total curative effects in the BillrothⅡ anastomosis and Roux-en-Y anastomosis groups were significantly better than those in the BillrothⅠ anastomosis group （P＜0.05）. Conclusion According to our limited clinical data， BillrothⅡ anastomosis and Roux-en-Y anastomosis for gastric antral cancer patients with type 2 diabetes may be the best surgical approach.
ObjectiveTo investigate the ideal digestive tract reconstruction method for radical distal gastrectomy (DG). MethodsClinical and follow-up data of 862 patients with gastric cancer who underwent DG in Xijing Hospital of Digestive Diseases of The Fourth Military Medical University from January 2010 to January 2013 were analyzed retrospectively. According to reconstruction methods, patients were divided into three groups:Billroth Ⅰ group (B-Ⅰgroup), Billroth Ⅱ (B-Ⅱ)+Braun group (B-Ⅱ+Braun group), and Roux-en-Y group. In order to reduce the difference of clinicopa-thological characteristics, Gmatch method was used to select patients basing on gender, age (±5 years), tumor size (±1 cm), pT staging, and pN staging. The perioperative data, recent (30 days after surgery) complications, gastroscopic results over one year, and postoperative survival rate were compared respectively among the 3 groups. Results① Perioperative indexes. The operative time, postoperative hospitalization, and semi liquid diet time were significantly different among 3 groups (P < 0.050). As compared with B-Ⅱ+Braun group and Roux-en-Y group, B-Ⅰ group had a significantly shorter operative time (P < 0.012 5), and there was no significant difference between B-Ⅱ+Braun group and Roux-en-Y group (P > 0.012 5). As compared with B-Ⅱ+Braun group, B-Ⅰ group had a significantly shorter semi liquid diet time (P < 0.012 5), but there was no significant difference between B-Ⅱ+Braun group and Roux-en-Y group, as well as Roux-en-Y group and B-Ⅰ group (P > 0.012 5). As compared with B-Ⅰ group and B-Ⅱ+Braun group, Roux-en-Y group had a significantly longer postoperative hospitalization (P < 0.012 5), and there was no significant difference between B-Ⅰ group and B-Ⅱ+ Braun group (P > 0.012 5). ② There was no significant difference in recent complications between Roux-en-Y group (12.5%, 4/32), B-Ⅱ+Braun (6.2%, 2/32), and B-Ⅰ group (3.1%, 1/32), P=0.495. ③ Results of endoscopic examination over 1 year after radical DG showed that there was significant difference among 3 groups (P < 0.050). Compared with B-Ⅰ group and B-Ⅱ+Braun group, the rates of reflux gastritis, bile reflux, and reflux esophagitis of Roux-en-Y group were all lower (P < 0.012 5), but there was no significant difference between B-Ⅰ group and B-Ⅱ+Braun group (P > 0.012 5).④ The 3-year survival rates of Roux-en-Y group, B-Ⅱ+Braun group, and B-Ⅰ group were 70.0% (21/30), 73.3% (22/30), and 75.0% (24/32) respectively, and there was no significant difference in the survival situation (P=0.911). ConclusionsThe effect of Rouxen-Y anastomosis on resisting gastrointestinal reflux is remarkable. B-Ⅰanastomosis has the advantages of more simple operation, faster recovery, and more similar to the physiological structure. Thus, B-Ⅰ anastomosis and Roux-en-Y anastomosis are recommended for digestive tract reconstruction in DG.
Objective To evaluate the clinical application of modified Orr Roux-en-Y type digestive tract reconstruction. Methods Thirty-eight patients with gastric cancer were randomly classified into modified group （accepted modified Orr Roux-en-Y type digestive tract reconstruction, 18 cases） and ρ group （accepted ρ type esophagojejunostomy, 20 cases） according to the date of operation. Operative time, blood loss in operation, complications after operation, emptying time of pouch, and change of body weight before and 3 months after operation were compared between two groups. Results Compared with the ρ group 〔(283±35) min〕, the operative time of modified group 〔(229±18) min〕 was significantly shorter （Plt;0.05）. The holo-empyting time of pouch in modified group 〔(35.7±4.9) min〕 was longer than that in ρ group 〔(3.0±0.5) min〕, Plt;0.01. Blood loss in operation, complications after operation, and the body weight change had no statistical difference between two groups （Pgt;0.05）. Conclusion Modified Orr Roux-en-Y type reconstruction with a pouch function is useful in clinical application， which is not only easy to operate, but also can reduce the operative time and the complications.
Objective To investigate for a reasonable reconstruction method in patients undergoing total gastrectomy. Methods Data of 63 cases receiving total gastrectomy from January 2000 to October 2005 in Ganzhou District Hospital of Zhangye City were analyzed retrospectively, and the patients were divided into double pouch jejunum interposition （DPJI） group (n=30) and Roux-en-Y ρ pouch （RYρ） group (n=33) according to the operation methods, then operation time， morbidity of complications, amount and frequency of meat and drink, complications of digestive tract, amount of total protein and albumin were compared between two groups. Results There were no significant differences in operation time，morbidity of complications, the amount or frequency of meat and drink between two groups (Pgt;0.05); but the incidence of digestive tract complications of DPJI group was lower than that of RYρ group （P＜0.05). GradeⅠ/Ⅱof Vervaeck index and the amount of total protein and albumin in DPJI group were statistical significantly higher than those of RYρ group （P＜0.05）. Conclusion Functional DPJI is a reasonable digestive tract reconstruction method.
ObjectiveTo compare clinical efficacy of totally laparoscopic gastrectomy (TLG) and conventional laparoscopy-assisted gastrectomy (LAG) and to explore safety and feasibility of total laparoscopic anastomosis in laparoscopic gastrectomy. MethodThe clinical data of 64 patients who received TLG and another 70 patients who received conventional LAG in our department from January 2013 to March 2014 were retrospectively analyzed. ResultsAll procedures were completed successfully. There were no significant differences in the time of anastomosis〔(73.8±10.3) min versus (72.7±8.9) min, t=0.693, P=0.489〕 and the number of dissected lymph nodes (32.4±9.7 versus 33.6±9.6, t=-0.700, P=0.485) between the patients underwent TLG and the patients underwent LAG. However there were obvious differences in the blood loss〔(275.0±66.3) mL versus (364.3±75.7) mL, t=-7.419, P=0.000〕, the incision length〔(3.0±0.8) cm versus (7.3±1.7) cm, t=-19.354, P=0.000〕, the time to fluid diet〔(4.9±0.8) d versus (6.0±0.7) d, t=-8.750, P=0.000〕 and the time to flatus 〔(2.8±0.8) d versus (3.9±0.8) d, t=-8.388, P=0.000〕, the off-bed time〔(1.3±0.5) d versus (3.4±1.2) d, t=-14.118, P=0.000〕, and the hospital stay〔(9.8±1.2) d versus (13.0±1.5) d, t=-17.471, P=0.000〕 between the patients underwent TLG and the patients underwent LAG. Meanwhile it was found that the postoperative pain score〔On day 1 postoperatively: (3.4±0.8) points versus (6.2±1.3) points, t=-15.509, P=0.000; on day 3 postoperatively: (1.7±0.6) points versus (4.0±0.8) points, t=-18.799, P=0.000〕 and the dosage of pain killers (1.7±0.7 versus 4.0±2.1, t=-8.912, P=0.000) in the patients underwent TLG were significantly lower than those in the patients underwent LAG. One patient developed anastomotic leakage and 3 patients developed anastomotic stenosis in the patients underwent LAG, the complication rate related to the anastomosis was 5.7% (4/70). While there were no complications related to the anastomosis in including anastomotic leakage, stenosis, and bleeding in the patients underwent TLG. ConclusionsTotal laparoscopic anastomosis is safe and feasible in laparoscopic gastrectomy for gastric cancer. Compared with small incision-assisted anastomosis, totally laparoscopic anastomosis is associated with minimal trauma, less blood, quicker postoperative recovery, shorter time, slighter pain and satisfactory short-term efficacy.
Objective To evaluate whether jejunal interposition pouch (JIP) reconstruction is an ideal procedure of digestive tract reconstruction after total gastrectomy. Methods Ninetyfour patients after total gastrectomy had randomly divided into two groups, JIP group 42 cases and RouxenY pouch (RYP) group 52 cases. The gastrointestinal function improvement in body weight and nutritional parameters (serum albumin, hemoglobin level, and serum protein) were compared 1 year after surgery for the two groups. Results The nutritional condition of JIP group and RYP group after operation had improved (P＜0.01); and the condition of JIP group with fewer symptom problems demonstrated much more better than standard RYP group （P＜0.01）. Conclusion JIP that could obtain partly compensatory function after total gastrectomy is an ideal reconstruction.
Foreign body in the digestive tract is one of the common critical diseases in the gastroenterology department, and it is the most common in children. Due to the wide variety of foreign body ingestion, the treatment methods are diverse, and the potential risks and complications are constantly escalating. If the treatment is not timely or improper, serious consequences will occur. However, there are no guidelines for foreign bodies in the digestive tract for children in China. Therefore, the development of evidence-based guidelines for the management of foreign bodies in the digestive tract of children, based on clinical practice in China, is of great significance in effectively guiding and promoting the management of foreign bodies in the digestive tract of children. In order to provide guidance and decision-making basis for clinicians at all levels who treat children with foreign bodies in the digestive tract, we complied with standard development process, collaborated with multidisciplinary expertise, based on available evidence, combined with clinical practice, adopted the grading of recommendations assessment, development and evaluation (GRADE) approach, and followed the reporting items for practice guidelines in healthcare (RIGHT) to develop this guideline for the management of foreign bodies in the digestive tract of children.
ObjectiveTo explore the application of different digestive system management strategies in the perioperative period of thoracolumbar fracture.MethodsThe clinical data of the patients with thoracolumbar fractures and pedicle screw fixation in Affiliated Hospital of Southwest Medical University from January 2016 to January 2018 were retrospectively analyzed. According to different perioperative management strategies of the digestive system, they were divided into two groups. Patients with careful management strategy were included in the observation group, and patients with routine management were included in the control group. The baseline conditions, the abnormalities of digestive tract function at admission and before and after surgery, the postoperative first feeding time, exhaust time, defecation time, the incidence of other postoperative complications except digestive tract complication, length of stay and patient satisfaction were compared between the two groups. At 6 months after surgery, the fracture healing, loosening or fracture of internal plants were compared between the two groups.ResultA total of 121 patients were included in the study, including 67 cases in the observation group and 54 cases in the control group. There was no significant differences in the baseline conditions between the two groups (P>0.05). There were no significant differences between the two groups in the incidences of digestive system dysfunction at admission (P>0.05). The incidences of digestive system dysfunction in the observation group before and after surgery were lower than those in the control group (29.9% vs. 53.7%, P<0.05; 35.8% vs. 61.1%, P<0.05). The first eating time [(3.7±1.1) vs. (6.7±2.6) h], exhaust time [(7.8±2.3) vs. (13.6±4.2) h], defecation time [(26.7±8.1) vs. (40.9±11.2) h] and length of stay [(6.5±2.4) vs. (9.0±2.7) d] in the observation group were shorter than those in the control group (P<0.005), and the patients’ satisfaction was better than that of the control group (8.3±1.1 vs. 7.6±1.3; t=−3.208, P=0.002). There was no statistically significant difference in the incidence of postoperative complications except digestive tract complication, and the fracture healing rate, the incidence of nail-rod breakage at6 months after surgery between the two groups (P>0.05). No internal plant loosening was found in the two groups of patients within 6 months after surgery.ConclusionThe application of the careful digestive system management strategy in patients with thoracolumbar fractures can help reduce the incidence of perioperative gastrointestinal dysfunction, promote the recovery of perioperative gastrointestinal function, shorten the length of hospital stay, and improve patient satisfaction.
To investigate the effect of BMSCs on the repair of digestive tract injury and its mechanisms.Methods Recent l iterature on the effect of BMSCs on the repair of digestive tract injury was reviewed. Results BMSCs had the potency of self-repl ication, prol iferation and multipotential differentiation, which played an important role in the repair of digestive tract injury. The probable mechanisms included: BMSCs’ abil ity of migrating to the injured tissue and inhibiting the host immune response; BMSCs’ dedifferentiation and redifferentiation; BMSCs’ direct differentiation into the epithel ial cellsor the stem cells of digestive tract; BMSCs’ fusion with the stem cells or the mature epithel ial cells of digestive tract; BMSCs’ participation in the reconstruction of injured microenvironment. Conclusion BMSCs participates in the repair of digestive tract injury and has a bright future in the treatment of digestive system disease.
Motor function was investigated by constant perfusion manometry in the Roux limb of ten patients who had undergone total gastrectomy and Roux-en-Y anastomosis. Results showed that in the fasting state, the migrating motor complex (MMC) was comletely absent, retrograde in direction or bursts of nonphasic pressure activity. Reduced motor activity patterns occurred after the meal in some patients. Four patients failed to convert fasting state into the feeding state. Total gastrectomy with Roux-en-Y anastomoses provakes a relatively severe distubance in motor function, which could contribute to postoperative upper abdominal distress.