食管癌切除术后食管端端吻合的测压观察

Manometric observation after resection of esophageal carcinoma combined with esophageal end-to-end anastomosis

有人认为食管癌切除后保留食管末端（包括食管下括约肌）、食管端端吻合并行胃底折叠术可防止术后的胃食管返流。作者对行此术式的１４例胸中段食管癌患者进行了术前术后食管压力测定。术前食管下括约肌压力在正常范围，为２．５７±０．２１ｋＰａ，与正常人对照组２．５１±０．４８ｋＰａ无明显差别（Ｐ＞０．０５）。术后患者食管下括约肌压力下降到１．６６±０．４０ｋＰａ，与术前值有明显差别（Ｐ＜０．０５）。手术后胸腔胃压力为１．０９±０．４４ｋＰａ，残余食管压力为１．０２±０．３６ｋＰａ，相差无几，说明食管与胃之间存在一共通腔。可以认为，保留的食管下括约肌已不再能起抗返流屏障的作用。

It was believed that if the distal end of the esophagus(lower esophageal sphincter,LES)waspreserved intact, and esophageal end-to-end anastomosis combined gastric fundoplication weremade,postoperative gastroesophageal reflux(GER)could be prevented.such operation has beendone in 14 cases with middle third esophageal cancer by the authors.Manometry before operationshowed that the mean value of pressure of the LES was within normal range,2.57±0.21kPa.Noobvious difference compared with that of the control group(n=30,x=2.51±0.48kpa)(P>0.05 ).Postoperatively, the mean value of the LES pressure was 1.66±0.40kpa,it was obviouslylower than that of preoperative determination(P<0.05).Postoperative pressure of intrathorcicstomach was 1.09±0.44kPa,and that of residual esophagus was 1.02±0.36kpa. So,there wasa common cavity between intrathoracic stomach and residual esophagus as the pressures of bothwere similiar.It was considered that preserved LES no more was a barrier for preventing GER.