食管癌分别行管状胃代食管吻合术与传统全胃代食管吻合术对术后胃食管反流病情的控制效果

摘要

目的 对比食管癌分别行管状胃代食管吻合术与传统全胃代食管吻合术对术后胃食管反流病情的控制效果.方法 将2010年9月至2015年10月期间在亳州市人民医院确诊并接受择期食管癌切除术治疗的85例食管癌患者随机分为研究组(45例)与对照组(40例),2组患者均接受食管癌切除术治疗,其中研究组行管状胃代食管吻合术,对照组行传统全胃代食管吻合术.术后待患者恢复正常的胃肠道功能后采用pH动态监测仪对其进行24h胃代食管腔pH监测,术后1、3月依据RDQ量表对患者的胃食管反流相关症状进行评分,同时统计术后1、3月的胃食管反流的发生情况.结果 2组患者均未出现死亡病例,且术后均未发生有吻合口瘘及胸胃排空障碍并发症;2组患者几乎均达到24h的全程监测,同时组间比较监测总时间、立位监测时间、卧位监测时间均无统计学意义(P＞0.05);研究组的24 h反流次数及长返流次数显著少于对照组,反流持续最长时间与pH值＜4.00的累计时间显著短于全胃组,DeMeester评分显著低于对照组,组间比较均有统计学意义(P＜0.01);研究组术后1、3月的RDQ评分以及胃食管反流发生率均显著低于对照组,组间比较均有统计学意义(P＜0.01或P＜0.05).结论 管状胃代食管吻合术较传统全胃代食管吻合术可对食管癌切术后的胃食管反流病情起到更为理想的控制效果,可为食管癌患者术中吻合术式的选择提供一定参考价值.%Objective To compare the control effect on postoperative GER disease between tubular EC stomach esophagus anastomosis and the traditional full stomach esophagus anastomosis.Methods From September 2010 to October 2015 in Bozhou People's Hospital,85 patients diagnosed with esophageal cancer undergoing elective resection were randomly divided into a tubular stomach EC group (45 cases) and total gastrectomy group (40 cases),two patients underwent esophageal resection,wherein the tubular stomach set of rows of tubular esophagus stomach anastomosis,total gastrectomy group underwent conventional full stomach esophagus anastomosis.After the surgery until the patient to return to normal gastrointestinal function uses dynamic monitor its pH 24h esophageal pH monitoring chamber,the other respectively after 1 March using RDQ Scale GER-related symptoms in patients with score,at the same time Statistics after 1 March of the occurrence of GER.Results There were no deaths occurred,and no occurrence of postoperative anastomotic fistula and thoracic gastric emptying dysfunction,etc;the two groups were almost reached full monitoring 24 h,and between groups while monitoring the total time,Li position monitoring time,there was no significant supine monitoring time (P＞0.05);24 h reflux episodes long tubular gastric reflux group and significantly less than the number of total gastrectomy group,the longest duration of reflux and pH value ＜4.00 The cumulative time was significantly shorter in total gastrectomy group,DeMeester scores were significantly lower than the total gastrectomy group,between groups were statistically significant (P＜0.01);postoperative gastric tube 1,March RDQ score and incidence of GER significantly lower than the total gastrectomy group,between groups were statistically significant (P＜0.01 or P＜0.05).Conclusion Tubular stomach esophagus anastomosis compared with conventional full stomach esophagus anastomosis resection of esophageal cancer has a more ideal GER disease control effect,and can provide a reference for the choice of nastomosis ways for patients with esophageal cancer surgery.