Residue Sinus Syndrome

　　The cause of residual antrum syndrome is that the mucosa of the residual antrum is stimulated by refluxed alkaline duodenal juice, resulting in an excessive amount of gastrin. After absorption into the blood, it acts on the mucosa at the bottom of the stomach, stimulating the parietal cells of the residual stomach, causing excessive secretion of gastric juice, high levels of stomach acid, and postoperative anastomotic ulcer. It can spread to the muscular layer or serous layer. Edema, inflammatory cell infiltration, and fibrous tissue proliferation occur in the affected area, causing thickening and even narrowing of the local area; in some cases, there may be erosion of the mucosal surface and changes in the epithelium of the intestinal glands.

　　The residual antrum is prone to recurrent ulcers. The prognosis is usually poor. Severe symptoms such as stomach pain, nausea, bloating, and so on can be treated quickly with Western medicine for对症 treatment, and attention should be paid to health preservation, regular life, reasonable diet, keeping the bowels smooth, moderate rest, moderate exercise, and emotional stability, etc.

　　Typical symptoms include excessive secretion of gastric juice and a series of symptoms caused by anastomotic ulcer, such as long-term, periodic, and hunger pain in the upper abdomen, burning sensation in the upper abdomen, acid regurgitation, belching, and so on.

　　Diagnosis can be made according to the surgical history and clinical manifestations, and gastroscopy can help clarify the diagnosis. Some patients are diagnosed during a second surgery. Typical symptoms include excessive secretion of gastric juice and a series of symptoms caused by anastomotic ulcer, such as long-term, periodic, and hunger pain in the upper abdomen, burning sensation in the upper abdomen, acid regurgitation, belching, and so on.

　　The cause of this syndrome is that the residual gastric antrum mucosa is stimulated by refluxed alkaline duodenal fluid, producing a large amount of gastrin, which is absorbed into the blood and acts on the mucosa at the bottom of the stomach, stimulating the residual gastric wall cells to promote excessive secretion of gastric juice, high acid content, and postoperative anastomotic ulcer. Pork, duck meat, and pigeon meat can be eaten. Eat less beef, mutton, dog meat, chicken, fish and shrimp, spicy foods, and eat less cold, greasy, fried, pickled, and smoked foods, etc.

　　Fiber endoscopy and upper gastrointestinal barium meal examination are not satisfactory for diagnosing residual antrum, and the preoperative diagnosis of residual antrum syndrome is relatively difficult. Most patients are diagnosed only when the duodenal residual end is explored during surgery.

　　First, pay attention to postoperative diet after gastric surgery:

　　1. Chew slowly and swallow slowly:Food stimulates the secretion of saliva (containing enzymes beneficial for the digestion of carbohydrates) in the mouth, and careful chewing can make the food particles smaller. The saliva and food are fully mixed, replacing part of the stomach function. Slow swallowing refers to slow swallowing and long intervals between swallows to prevent the倾倒综合症 (syncope syndrome) caused by rapid swallowing of a large amount of food.

　　2. Small and frequent meals:The capacity of the residual stomach or the newly connected intestinal segment after surgery cannot be compared to before, and the body needs a longer period of time to adapt to this change. Clinical experience shows that it takes at least 8-10 months to recover to a normal three-meal-a-day diet. The initial intake should be 5-8 times a day, with each intake of 50-100 grams, gradually increasing the intake and reducing the frequency of meals according to the patient's tolerance (good tolerance is indicated by no bloating or discomfort). The process of adaptation varies due to individual differences.

　　3. Diversified diet:The variety of food can be chosen according to the patient's dietary preferences and habits, but attention should be paid to consuming as much nutritious and easily digestible high-protein, high-vitamin diet as possible. For example, fish, eggs, fresh vegetables, fruits (it is best to drink juice), and so on. It is important to supplement iron, eat more iron-rich foods such as animal liver, spinach, and soy products, and drinking some yogurt is also beneficial.

　　4. Postprandial Position:For surgery to remove the entrance of the stomach, to prevent food from regurgitating after eating, maintain a sitting or inclined position; for surgery to remove the outlet of the stomach, to prevent food from running down quickly after eating, lie down and rest for about 20 minutes first, then take a free position.

　　5. Take some drugs as prescribed after meals:For example, digestive drugs, vitamin B12, folic acid, etc., help digestion and absorption and prevent anemia from occurring.

　   Secondly, diet restrictions should be imposed:

　　Firstly, fried, spicy, and刺激性 food, raw, cold, and hard food should be avoided. Also, food that is too hot, too sweet, or too salty should be limited appropriately.

　　1. Traditional Chinese Medicine Treatment:

　　Dialectical analysis: Cold and blood stasis. Treatment: Warm the heart-yang, dissipate blood stasis and relieve obstruction. Formula name: Wenyang Tongmai Decoction. Composition: Raw ma huang 6-12 grams, well-cooked fu piece 12-24 grams (decocted first), fine leek 12 grams, whole loofah 12-30 grams,枳壳9 grams, hamomelis 9 grams, safflower 6 grams, chuanxiong 10 grams, hu Zhang 12 grams. Administration: Decocted for oral administration, 1 dose per day, twice a day.

　　2. Acupuncture

　　Acupuncture points: Main points: Neiguan, Shenshu, Dalang, Taixi, Shentang. Auxiliary points: Shenmen, Wangu, Geshu, Zhishi, Changzhong, Zusanli. Or the first group of main points take Neiguan, Shenmen, and match Zusanli; the second group of main points take Shenshu, Shentang, and match Sanyinjiao. Operation: Take 2 points from the main points each time, match the chest, back, and limbs, and add auxiliary points as appropriate. All points are taken on both sides. When needling Shenshu and Shentang, take a prone position, needle the body at a 70° angle to the spinal direction, and the depth is 1 cun. The main method is to supplement, and warm-needling moxa is applied to Shentang and Zhishi points, and the rest of the points can be used with G6805 therapeutic instrument for electrical stimulation. The points are alternated, once a day, needle retention for 30-40 minutes, needle twice in the middle, about 1 minute each time, 7 days as a course, and 1 day between courses. Western medical treatment for residual antrum syndrome

　　3. Surgical Treatment:In terms of treatment, it is necessary to completely remove the residual antrum and restore the normal, physiological duodenal passage, that is, to change from Billroch II to I type, and some advocate adding bilateral vagus nerve trunk section at the same time if the stomach and duodenum are directly anastomosed end-to-end and the free jejunal loop replacement surgery is performed.