ObjectiveTo evaluate the safety and efficacy of Roux-en-Y reconstruction with isolated pancreatico-jejunostomy after pancreaticoduodenectomy. MethodsSystematically literature search was performed through PubMed, EMBASE, Cochrane Library, Wanfang, VIP, and CNKI from the earliest to November 30, 2015. Randomized clinical trials (RCTs) and controlled clinical trials (CCTs) comparing outcomes of Roux-en-Y reconstruction with isolated pancrea-ticojejunostomy and conventional pancreaticojejunostomy were searched. The data were applied meta-analysis by RevMan 5.3. ResultsSeven trials were involved, two RCTs including 367 patients and five CCTs including 431 patients. Meta-analysis result showed that there was no statistic significant difference in pancreas fistula between Roux-en-Y reconstruction with isolated pancreaticojejunostomy and conventional pancreaticojejunostomy. ConclusionRoux-en-Y reconstruction with isolated pancreaticojejunostomy after pancreaticoduodenectomy is not superior to conventional pancreaticojejunostomy regarding pancreatic fistula rate or other relevant outcomes.
The incidence of esophagogastric junction adenocarcinoma is gradually increasing, and gastrointestinal surgery and thoracic surgery are paying more and more attention to its surgical treatment. “Chinese expert consensus on the surgical treatment of adenocarcinoma of esophagogastric junction (2018 edition)” discussed the core issues in the field of surgical treatment such as definition, classification, surgical approach, lymphadenectomy, digestive tract reconstruction, and neoadjuvant therapy for esophagogastric junction adenocarcinoma, and gave recommendations. However, there is still some controversy about these issues. The author discussed the consensus and controversial issues relevant to esophagogastric junction adenocarcinoma and related research progress in recent years.
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 describe a new technique for digestive tract reconst ruction of total gast rectomy.Methods The modified functional jejunal interposition ( FJ I) was performed in 38 patient s who underwent total gastrectomy between June 2004 and March 2006. At digestive tract reconst ruction, the jejunum with suitable suture ligated at 2 cm distal to side-to-end jejunoduodenostomy was changed to sew up 2－3 needles and to narrow it . End-to-side esophagojejunostomy to Treitz ligament was shortened to 20－25 cm befittingly. Side2to2side jejunojejunostomy to Treitz ligament was 10 cm. Both esophagojejunostomy and jejunojejunostomy must not be tensioned. Results No patients died or had anastomotic leakage in perioperative period. Roux-en-Y stasis syndrome (RSS) was in 2 patients. The Visick grade: 35 patient s were grade Ⅰ, 3 patient s were grade Ⅱ. Serum nut ritional parameters in 2 patients hemoglobin was only lower than normal. At 6 months after operation , food intake per meal and body weight were recovered to the preoperative level in 36 patients, and only 2 patients appeared weight worse. One patient had reflux esophagitis and no dumping syndrome occurred. Through the upper gast rointestinal radiograph , the bariums entered into duodenal channels mostly , and a little into the narrow channels. Conclusion The modified FJ I not only reserved all advantages of the primary procedure , but also could further lower the complications and improve of the quantity life of the patients who were underwent total gast rectomy. It would be necessary for further prospective randomized controlled trial in tlhe largescale cases.
Objective To explore the optimal technique for digestive tract reconstruction of proximal gastrectomy. Methods Fifty-nine patients who underwent proximal subtotal gastrectomy during June 2004 and January 2007 were analyzed retrospectively. All patients were divided into 2 groups according to the styles of reconstruction: one group with gastroesophagostomy (GE group) and the other with accommodation double tract digestive reconstruction of jejunal interposition (GIE group). The reconstruction of GIE group was to interposite a continuous 35 cm jejunum between the gastric stump and the oesophagus, which detail had been reported in our previous literature. The quality of life in 2 groups were evaluated and compared. Results No patient died and there was no anastomotic leakage, dumping syndrome and moderate or severe anemia occurred during perioperative period. There was no significant difference of the following indexes of nutrition between 2 groups 1 month and 6 months after operation: the value of weight, RBC, Hb, Alb, PNI and the indexes versus the preoperative ones (Pgt;0.05), for the exception of the indexes of RBC (P=0.006), Hb (P=0.001) in 1 month after operation versus the preoperative ones. The abdominal and the reflux esophagitis symptoms in GIE group were milder than those in GE group (Plt;0.001). The Visick scoring: most of the GIE group were gradeⅡ (74.2%), and grade Ⅲ (64.3%) in the GE group. There was no delay of the first time of adjuvant chemotherapy in GIE group (Pgt;0.05), and the surgical time was (0.35±0.13) h more than that of GE group (P=0.01). Conclusion The accommodation double tract digestive reconstruction of jejunal interposition for proximal subtotal gastrectomy may be safe and feasible by decreasing residual cancer cells and improving the quality of life of patients with proximal gastric carcinoma who underwent such surgical procedure.