胸段食管癌切除术中保留迷走神经干的可行性探讨

CLINICAL STUDY ON THE FEASIBILITY OF PRESERVING VAGAL TRUNKS IN THE SURGICAL TREATMENT OF CARCINOMA OF THE THORACIC ESOPHAGUS

作者对４７例胸段食管癌手术中保留迷走神经干行分组对比研究，其中保留神经组２０例，常规手术对照组２７例。保留组１８例和对照组２６例行根治性手术；余为姑息性手术。病理学检查发现保留组３例（１５．０％）和对照组３例（１１．１％）癌已浸润近迷走神经干或／和其分支附近；另外，保留组１例（５．０％）和对照组３例（１１．１％），癌已侵及神经。基础胃酸分泌量（ＢＡＯ）及胃排空时间（Ｔ１／２）测定：保留组ＢＡＯ均数值（１．９３ｍｍｏｌ／ｈ）和Ｔ１／２均数值（６３．５１分）与对照组ＢＡＯ（０．７５ｍｍｏｌ／ｈ）和Ｔ１／２（＞１０５分）之间的差别皆显著；而与正常人组和术前对照组相比则差异无显著性意义。作者认为，术中保留迷走神经是可行的，术后胃的泌酸及运动功能损伤轻。但手术指征应限于Ｔ１～Ｔ２等较早期的病变，否则会影响手术的根治性。

Abstract The results of preserving vagal trunks in the surgical treatment of 47 patients with the carcinomaof the thoracic esophagus were discussed through a controlled study. There were 20 patients in thetest group with vagus nerve being preserved(PG) and 27 in the control group(CG) with vagus nervebeing routinely severed. Eighteen patients in PG and 26 in CG underwent radical resections, the re-maining ptients received palliative surgery. Pathological findings showed that 3 cases (15.0%)in PGand 3 cases(11)in CG had cancerous invasion near the vagal trunks and/or their main branchsclose to the primary cancer; and 1 case(5.0%)in PG and 3(11.1%)in CG the vagal nerves wereactually invaded by cancer cells. Determinations of basal gastric acid output(BAO)and half gastricemptying time(T1/2)revealed that the mean value of BAO.93mmol/h)and T1/2(63.51min.)of the PG were statistically different from those of 0.75mmol/h and>105min. in CG , but similar tothose of the healthy group and the preoperative control values. We consider that it is feasible to pre-serve vagal trunks in the operation and is beneficial in minimizing of postoperative disturbances of gas-tric acid output and gastric motility; but the indications of this procedure should only be limited toT1～T2 lesions in order not to jeopardize the radicality of tumor resection.