管状胃食管吻合术与传统食管胃弓上吻合术治疗食管癌的效果比较

摘要

目的 比较管状胃食管吻合术与传统食管胃弓上吻合术治疗食管癌患者的临床疗效.方法 选择2008年1月至2013年12月西安高新医院接诊的104例行根治术的食管癌患者为研究对象,采用随机数字法将患者分为管胃食管吻合术组和食管胃弓上吻合术组,各52例,食管胃弓上吻合术组患者采用传统食管胃上弓吻合术治疗,管状胃食管吻合术组患者采用管状胃食管吻合术治疗.比较两组患者的肺功能变化、食管内pH值、并发症发生情况.结果 手术后两组患者肺活量占预计值百分比、最大通气量占预计值百分比及第1秒用力呼气量(FEV1)占预计值百分比与手术前比较均显著降低(P＜0.05),但管状胃食管吻合术组治疗后肺活量占预计值百分比、最大通气量占预计值百分比及FEV1占预计值百分比高于食管胃弓上吻合术组[(76.4±16.3)％比(62.4±21.1)％,(83.6±17.5)％比(63.8±16.2)％,(85.6±22.7)％比(65.3±21.4)％](P＜0.05或P＜0.01);术后管状胃食管吻合术组患者24h酸反流次数、＞5 min酸反流次数次、最长酸反流时间及pH ＜4的总时间均短于食管胃弓上吻合术组[(17.5±6.3)次比(43.6±11.8)次、(2.4±1.8)次比(6.8±2.3)次、(25.1±5.4) min比(33.5±7.3) min、(82.7±36.4) min比(131.9±37.6) min] (P ＜0.01);管状胃食管吻合术组的总并发症发生率低于食管胃弓上吻合术组[11.54％(6/52)比32.69％ (17/52)](P＜0.01).结论 管状胃食管吻合术较传统食管胃弓上吻合术可改善食管癌术后胸腔胃对呼吸功能的影响,提高肺部功能,降低术后胃食管反流症状,降低并发症的发生率,改善患者的生活质量.%Objective To evaluate the effect of tubular esophageal anastomosis and traditional esophageal stromal anastomosis on postoperative pulmonary function among patients with esophageal cancer.Methods A total of 104 patients with esophageal cancer who underwent radical surgery in Gaoxin Hospital from Jan.2008 to Dec.2013 were selected as the subjects.The patients were divided into a tubular esophageal anastomosis group and an esophagogastric anastomosis group according to the random number method,52 cases each group.The esophagogastric anastomosis group received traditional esophageal sternal anastomosis treatment,while the tubular esophageal anastomosis group received tubular esophageal anastomosis treatment.The lung function,esophageal pH,complications of the two groups were compared.Results After operation,the vital capacity percentage of predicted lung volume(VC％),maximal voluntary ventilation percentage(MVV％) and forced expiratory volume in first second percentage(FEV1 ％) of the two groups were significantly lower than before surgery (P ＜ 0.05),but the VC％,MW％ and FEV1 ％ of the tubular esophageal anastomosis group were higher than those of the esophagogastric anastomosis group[(76.4 ± 16.3) ％ vs (62.4 ± 21.1) ％,(83.6 ± 17.5) ％ vs (63.8 ± 16.2) ％,(85.6 ± 22.7) ％ vs (65.3 ± 21.4) ％] (P ＜ 0.05 or P ＜ 0.01).The times of 24 hours acid reflux and 5 min acid reflux,the longest acid reflux time and the time of pH ＜ 4 of the tubular esophageal anastomosis group were less or shorter than those of the esophagogastric anastomosis group [(17.5 ± 6.3) times vs (43.6 ± 11.8) times,(2.4 ± 1.8) times vs (6.8 ±2.3) times,(25.1 ±5.4) min vs (33.5 ±7.3) min,(82.7 ±36.4) min vs (131.9 ±37.6) min] (P ＜0.01),the total complications incidence was lower than that of the esophagogastric anastomosis group[11.54％ (6/52) vs 32.69％ (17/52)] (P ＜ 0.01).Conclusion Compared with esophagogastric anastomosis,tubular esophageal anastomosis can improve the postoperative function of thoracic cavity and improve the lung function,reduce the symptoms of gastroesophageal reflux and the incidence of complications,and better the quality of life of patients with esophageal cancer.