TOTAL GASTRECTOMY WITH SIMULTANEOUS RECONSTRUCTIVE JEJUNOGASTROPLASTY IN ACUTE BLEEDING GASTRIC CANCER
E.N SHEPETKO, D.A. GARMASH
National Medical University after A.A.Bogomolets, Kiev, UKRAINE
Aim: To improve the functional results of total gastrectomy for acute bleeding gastric cancer with the use of jejunogastroplasty (JGP).
Materials and methods: Were analyzed the results of 218 total gastrectomies, performed for complicated gastric cancer from 1983 to 2010 in the surgical clinic ¹3 of the National Medical University. Acute ulcer bleeding took place in 128 patients. Dissection in the extent of D1 and D2 was performed in all patients. Was developed a method of one-stage reconstructive JGP after total gastrectomy (Pat. UA ¹ 52020 A) by sewing the loops of jejunum in the form of letter F ("triple anastomosis"), as well as three ways of instrumental JGP after total gastrectomy in acute bleeding gastric cancer. One-stage reconstructive JPG after total gastrectomy with manual or instrumental suture was performed in 19 patients.
Results: Among 19 patients after gastrectomy with JGP males were 16 (84.2%), females - 3 (15.8%), 52.7% of them were in the age from 30 to 60. Patients were operated in the next stages of tumor: IB st. - 2 (10.5%), I² st. - 4 (21.0%), ²²²A st. - 5 (26.3%), ²²²B st. - 1 (5,3%), IV st. - 7 (36.9%). Mild blood loss was in 14 (73.7%), moderate - in 1 (5.3%), severe - in 4 (21%) cases. The degree of stability of hemostasis during endoscopic examination (according to Forrest): FIIA - 2 (10.5%), FIIB - 1 (5.3%), FIIC - 3 (15.8%), FIII - 13 (68.4%). The degree of cellular differentiation of cancer was as follows: G2 - 1 (5.3%), G3 - 9 (47.35%), G4 -9 (47.35%). Jejunogastroplasty was formed by the developed techniques with manual sewing in 3 (15.8%) patients, with instrumental - in 16 (84.2%), by the method of P-anasthomosis on a Roux loop (Pat. UA ¹ 52020 A) - in 6 (31.6%), by the method of F-anasthomosis with inclusion of duodenum - in 3 (15.8%), by Bondar's method with instrumental stitching of afferent and efferent intestinal loops and Brown's anasthomosis (Patent UA ¹ 41 335) - in10 (52.6%). Uncomplicated postoperative period was in 16 (84.2%) patients, acute postoperative pancreatitis developed in 2 patients (1 - JGP with manual suture, 1 - with apparatus suture), and perforation of acute ulcer of jejunum after JGP with manual suture, which required relaparotomy, developed in one patient. Lethal outcomes were not observed.
Conclusion: In acute bleeding gastric cancer in young and middle-aged patients it is useful to complement total gastrectomy with one-stage reconstructive JGP performed manually or by apparatus suture according to the developed techniques.
Date: 2014-12-28; view: 437