Study on Reconstruction of Digestive Tract Following Total Gastrectomy in Rats_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

NI Xiaochun , WANG Hexian , BIAN Bangjian , ZHANG Biao , JIANG Bojian.

Department of General Surgery, The Third Peoples Hospital, School of Medicine of Shanghai Jiaotong University, Shanghai 201900, ChinaCorresponding Author： JIANG Bo-jian, E-mail： Jiang_md@hotmail.com;

Corresponding author：

Keywords：

Total gastrectomy; Digestive tract reconstruction; Rat

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Objective 　To find out some ideal reconstructions after total gastrectomy in experimental study of rat.
Methods 　Sixty male Sprague-Dawley rats were randomly and averagely divided into 6 groups: Roux-en-Y group (RY group), proximate jejunal pouch group (PJP group), distal jejunal pouch group (DJP group), two jejunal pouchs group (TJP group), duodenum
jejunal pouch interposition group (DJPI group) and laparotomy group (L group). Body weight of rats, intestinal transit distance, adaptive changes in esophagojejunostomic mucosa and morphology changes of intestine after operation were observed and compared.
Results 　At 2 weeks after operation, body weight in each group were significantly lower than that before operation （P＜0.05）. At 4 weeks postoperatively, body weight in PJP group, TJP group and DJPI group were significantly higher than that in RY group respectively （P＜0.05）, as well as at 8 weeks. Intestinal transit distance in PJP group was shorter than that in RY group （P＜0.05）. With regard to intestinal mucosa, TJP group and DJPI group were significantly different with RY group （P＜0.05）. Interestingly, there was no difference in each group as to refluxing esophagitis （P＞0.05）.
Conclusion 　 Proximate and two jejunal pouchs Roux-en-Y esophagojejunostomy seem to be ideal procedures for digestive tract reconstruction after total gastrectomy. The jejunal pouch interposition procedure seems to be same effective to PJP and TJP, but there is no preponderance over the former.

Citation： NI Xiaochun,WANG Hexian,BIAN Bangjian,ZHANG Biao,JIANG Bojian.. Study on Reconstruction of Digestive Tract Following Total Gastrectomy in Rats. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2008, 15(8): 595-599. doi: Copy

1.	19　Kono K, Iizuka H, Sekikawa T, et al. Improved quality of life with jejunal pouch reconstruction after total gastrectomy [Ｊ]. Am J Surg, 2003; 185(2)∶ 150 20　Hoksch B, Zieren HU, Müller JM. Regular scintigraphic measurements of food transit following different types of reconstruction after total gastrectomy [Ｊ]. Arch Surg, 1999; 134(11)∶〖KG-7〗 1270.
2.	Schuhmacher C, Bttcher K, Siewert JR. Intestinal pouches: gastric reconstruction [Ｊ]. Chirurg, 1999; 70(5)∶ 520.
3.	Chin AC, Espat NJ. Total gastrectomy： options for the restoration of gastrointestinal continuity [Ｊ]. Lancet Oncol, 2003; 4(5)∶ 271.
4.	Liedman B. Symptoms after total gastrectomy on food intake, body composition, bone metabolism, and quality of life in gastric cancer patients—is reconstruction with a reservoir worthwhile？ [Ｊ]. Nutrition, 1999; 15(9)∶ 677.
5.	尹浩然. 从术式演变谈全胃切除术后消化道重建的原则 [Ｊ]. 中华胃肠外科杂志， 2004； 7(1)∶ 12.
6.	朱正纲. 全胃切除与消化道重建术在胃癌治疗中的临床意义[Ｊ]. 中国普外基础与临床杂志， 2006； 13(1)∶ 15.
7.	詹文华. 循证医学解决全胃切除后消化道重建之纷争 [Ｊ]. 中国普外基础与临床杂志， 2004； 11(2)∶ 100.
8.	中华医学会消化内镜学会, 中华消化内镜杂志编辑部. 返流性食管病（炎）诊断及治疗方法（试行） [Ｊ]. 中华消化内镜杂志, 2000； 17(1)∶60.
9.	Svedlund J, Sullivan M, Liedmen B, et al． Long term consequence of gastrectomy for patients quality of life： the impact of reconstructive techniques[Ｊ]. Am J Gastroenterol, 1999; 94(2)∶ 438.
10.	Hoksch B, Ablassmaier B, Zieren J, et al. Quality of life after gastrectomy: Longmires reconstruction alone compared with additional pouch reconstruction [Ｊ]. World J Surg, 2002; 26(3)∶ 335.
11.	Horváth OP, Kalmár K, Cseke L, et al. Nutritional and life-quality consequences of aboral pouch construction after total gastrectomy: a randomized, controlled study [Ｊ]. Eur J Surg Oncol, 2001; 27(6)∶ 558.
12.	Murawa D, Murawa P, Oszkinis G, et al. Long-term consequences of total gastrectomy: quality of life, nutritional status, bacterial overgrowth and adaptive changes in esophagojejunostomic mucosa [Ｊ]. Tumori, 2006; 92(1)∶ 26.
13.	Schwarz A, Büchler M, Usinger K, et al. Importance of the duodenal passage and pouch volume after total gastrectomy and reconstruction with the Ulm pouch: prospective randomized clinical study [Ｊ]. World J Surg, 1996; 20(1)∶ 66.
14.	Nakane Y, Michiura T, Inoue K, et al. A randomized clinical trial of pouch reconstruction after total gastrectomy for cancer: which is the better technique, Roux-en-Y or interposition? [Ｊ]. Hepatogastroenterology, 2001; 48(39)∶ 903.
15.	Fuchs KH, Thiede A, Engemann R, et al. Reconstruction of the food passage after total gastrectomy: randomized trial [Ｊ]. World J Surg, 1995; 19(5)∶ 698.
16.	Adachi S, Takeda T, Fukao K. Evaluation of esophageal bile reflux after total gastrectomy by gastrointestinal and hepatobiliary dual scintigraphy [Ｊ]. Surg Today, 1999; 29(4)∶ 301.
17.	Zonca P, Maly T, Herokova J, et al. Reconstruction after total gastrectomy [Ｊ]. Bratisl Lek Listy, 2002; 103(11)∶ 414.
18.	Iivonen MK, Koskinen MO, Ikonen TJ, et al． Emptying of the jejunal pouch and Roux-en-Y limb after total gastrectomy-a randomized, prospective study [Ｊ]. Eur J Surg, 1999; 165(8)∶ 742.
19.	Nakane Y, Akehira K, Okumura S, et al. Emptying of the jejunal pouch as a gastric substitute after total gastrectomy for cancer [Ｊ]. Hepatogastroenterology, 1997; 44(15)∶ 901.
20.	Ohwada S, Sato Y, Oriuchi N, et al. Gastric emptying after segmental gastrectomy for early cancer in the middle part of the stomach [Ｊ]. Hepatogastroenterology, 1999; 46(27)∶ 2081.
21.	Fujiwara Y, Kusunoki M, Nakagawa K, et al. Evaluation of J-pouch reconstruction after total gastrectomy: rho-double tract vs. J-pouch double tract [Ｊ]. Dig Surg, 2000; 17(5)∶ 475.
22.	Tomita R, Fujisaki S, Tanjoh K, et al. Studies on gastrointestinal hormone and jejunal interdigestive migrating motor complex in patients with or without early dumping syndrome after total gastrectomy with Roux-en-Y reconstruction for early gastric cancer [Ｊ]. Am J Surg, 2003; 185(4)∶ 354.
23.	Meyer L, Meyer F, Dralle H, et al. Insufficiency risk of esophagojejunal anastomosis after total abdominal gastrectomy for gastric carcinoma [Ｊ]. Langenbecks Arch Surg, 2005; 390(6)∶ 510.
24.	Zherlov G, Koshel A, Orlova Y, et al. New type of jejunal interposition method after gastrectomy [Ｊ]. World J Surg, 2006; 30(8)∶ 1475.
25.	杨培民. 全胃切除术后两种代胃术式的比较 [Ｊ]. 中华胃肠外科杂志， 2006； 9(1)∶ 23.
26.	Rea T, Bartolacci M, Leombruni E, et al. Study of the antireflux action of the Roux-en-Y jejunal loop in reconstruction after gastrectomy and nutritional status in the follow-up [Ｊ]. Ann Ital Chir, 2005; 76(4)∶ 343.
27.	Yumiba T, Kawahara H, Nishida T, et al. Jejunal pouch interposition with fundic-like plication after total gastrectomy [Ｊ]. Surg Today, 2005; 35(8)∶ 623.

1. 19　Kono K, Iizuka H, Sekikawa T, et al. Improved quality of life with jejunal pouch reconstruction after total gastrectomy [Ｊ]. Am J Surg, 2003; 185(2)∶ 150 20　Hoksch B, Zieren HU, Müller JM. Regular scintigraphic measurements of food transit following different types of reconstruction after total gastrectomy [Ｊ]. Arch Surg, 1999; 134(11)∶〖KG-7〗 1270.
2. 　Schuhmacher C, Bttcher K, Siewert JR. Intestinal pouches: gastric reconstruction [Ｊ]. Chirurg, 1999; 70(5)∶ 520.
3. 　Chin AC, Espat NJ. Total gastrectomy： options for the restoration of gastrointestinal continuity [Ｊ]. Lancet Oncol, 2003; 4(5)∶ 271.
4. 　Liedman B. Symptoms after total gastrectomy on food intake, body composition, bone metabolism, and quality of life in gastric cancer patients—is reconstruction with a reservoir worthwhile？ [Ｊ]. Nutrition, 1999; 15(9)∶ 677.
5. 　尹浩然. 从术式演变谈全胃切除术后消化道重建的原则 [Ｊ]. 中华胃肠外科杂志， 2004； 7(1)∶ 12.
6. 　朱正纲. 全胃切除与消化道重建术在胃癌治疗中的临床意义[Ｊ]. 中国普外基础与临床杂志， 2006； 13(1)∶ 15.
7. 　詹文华. 循证医学解决全胃切除后消化道重建之纷争 [Ｊ]. 中国普外基础与临床杂志， 2004； 11(2)∶ 100.
8. 　中华医学会消化内镜学会, 中华消化内镜杂志编辑部. 返流性食管病（炎）诊断及治疗方法（试行） [Ｊ]. 中华消化内镜杂志, 2000； 17(1)∶60.
9. 　Svedlund J, Sullivan M, Liedmen B, et al． Long term consequence of gastrectomy for patients quality of life： the impact of reconstructive techniques[Ｊ]. Am J Gastroenterol, 1999; 94(2)∶ 438.
10. 　Hoksch B, Ablassmaier B, Zieren J, et al. Quality of life after gastrectomy: Longmires reconstruction alone compared with additional pouch reconstruction [Ｊ]. World J Surg, 2002; 26(3)∶ 335.
11. 　Horváth OP, Kalmár K, Cseke L, et al. Nutritional and life-quality consequences of aboral pouch construction after total gastrectomy: a randomized, controlled study [Ｊ]. Eur J Surg Oncol, 2001; 27(6)∶ 558.
12. 　Murawa D, Murawa P, Oszkinis G, et al. Long-term consequences of total gastrectomy: quality of life, nutritional status, bacterial overgrowth and adaptive changes in esophagojejunostomic mucosa [Ｊ]. Tumori, 2006; 92(1)∶ 26.
13. 　Schwarz A, Büchler M, Usinger K, et al. Importance of the duodenal passage and pouch volume after total gastrectomy and reconstruction with the Ulm pouch: prospective randomized clinical study [Ｊ]. World J Surg, 1996; 20(1)∶ 66.
14. 　Nakane Y, Michiura T, Inoue K, et al. A randomized clinical trial of pouch reconstruction after total gastrectomy for cancer: which is the better technique, Roux-en-Y or interposition? [Ｊ]. Hepatogastroenterology, 2001; 48(39)∶ 903.
15. 　Fuchs KH, Thiede A, Engemann R, et al. Reconstruction of the food passage after total gastrectomy: randomized trial [Ｊ]. World J Surg, 1995; 19(5)∶ 698.
16. 　Adachi S, Takeda T, Fukao K. Evaluation of esophageal bile reflux after total gastrectomy by gastrointestinal and hepatobiliary dual scintigraphy [Ｊ]. Surg Today, 1999; 29(4)∶ 301.
17. 　Zonca P, Maly T, Herokova J, et al. Reconstruction after total gastrectomy [Ｊ]. Bratisl Lek Listy, 2002; 103(11)∶ 414.
18. 　Iivonen MK, Koskinen MO, Ikonen TJ, et al． Emptying of the jejunal pouch and Roux-en-Y limb after total gastrectomy-a randomized, prospective study [Ｊ]. Eur J Surg, 1999; 165(8)∶ 742.
19. 　Nakane Y, Akehira K, Okumura S, et al. Emptying of the jejunal pouch as a gastric substitute after total gastrectomy for cancer [Ｊ]. Hepatogastroenterology, 1997; 44(15)∶ 901.
20. 　Ohwada S, Sato Y, Oriuchi N, et al. Gastric emptying after segmental gastrectomy for early cancer in the middle part of the stomach [Ｊ]. Hepatogastroenterology, 1999; 46(27)∶ 2081.
21. 　Fujiwara Y, Kusunoki M, Nakagawa K, et al. Evaluation of J-pouch reconstruction after total gastrectomy: rho-double tract vs. J-pouch double tract [Ｊ]. Dig Surg, 2000; 17(5)∶ 475.
22. 　Tomita R, Fujisaki S, Tanjoh K, et al. Studies on gastrointestinal hormone and jejunal interdigestive migrating motor complex in patients with or without early dumping syndrome after total gastrectomy with Roux-en-Y reconstruction for early gastric cancer [Ｊ]. Am J Surg, 2003; 185(4)∶ 354.
23. 　Meyer L, Meyer F, Dralle H, et al. Insufficiency risk of esophagojejunal anastomosis after total abdominal gastrectomy for gastric carcinoma [Ｊ]. Langenbecks Arch Surg, 2005; 390(6)∶ 510.
24. 　Zherlov G, Koshel A, Orlova Y, et al. New type of jejunal interposition method after gastrectomy [Ｊ]. World J Surg, 2006; 30(8)∶ 1475.
25. 　杨培民. 全胃切除术后两种代胃术式的比较 [Ｊ]. 中华胃肠外科杂志， 2006； 9(1)∶ 23.
26. 　Rea T, Bartolacci M, Leombruni E, et al. Study of the antireflux action of the Roux-en-Y jejunal loop in reconstruction after gastrectomy and nutritional status in the follow-up [Ｊ]. Ann Ital Chir, 2005; 76(4)∶ 343.
27. 　Yumiba T, Kawahara H, Nishida T, et al. Jejunal pouch interposition with fundic-like plication after total gastrectomy [Ｊ]. Surg Today, 2005; 35(8)∶ 623.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Study on Reconstruction of Digestive Tract Following Total Gastrectomy in Rats

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