食管癌与贲门癌患者术后残余食管与胸腔胃功能研究

Functional study of the remnant esophagus and intrathoracic stomach in patients who underwent esophagectomy for cancer

目的了解食管癌与贲门癌患者术后残余食管和胸腔胃的病理生理变化,为提高患者术后生活质量提供客观依据。方法应用放射性核素胃排空、食管测压、24 h食管pH监测、电子胃镜、摄像上消化道造影和DeM eester烧心症状评分对92例食管癌与79例贲门癌术后患者进行客观检查,并与正常人进行对比分析。结果食管与贲门癌术后患者的胸胃排空较正常人明显延迟(t=7.105,P<0.01),且随时间推移有所改善,但术后1年仍未达到正常人水平(t=2.900,P=0.016)。食管癌切除术后患者,食管上括约肌关闭压和残余食管静息压均高于正常人(分别为t=2.275,P=0.03;t=2.160,P=0.039)。24 h食管pH监测发现89.7%的术后患者存在胃食管反流,半卧位的反流程度低于平卧位(t=3.074,P=0.005)。结论食管癌与贲门癌术后,胸胃排空明显延缓,且随时间推移逐渐改善,但很难达到正常人水平。食管与贲门癌术后广泛存在胃食管反流,采取半卧位可减轻反流。

Objective To investigate the pathophysiological changes of the remnant esophagus and intrathoracic stomach in the patients who underwent esophagectomy for cancer so as to provide objective evidence for the improvement of the postoperative quality of life, Methods The function of the remnant esophagus and intrathoracic stomach in 92 patients with carcinoma of esophagus and 79 patients with cardiac cancer aged 48-69 who underwent esophagectomy for cancer were assessed by gastric scintigraphy, esophageal manometry, 24-hour esophageal pH monitoring, electronic gastroscopy, videofluoroscopy, and DeMeester scoring system for assessment of heartburn. A certain number of healthy volunteers were used as controls in different tests. Results After esophagectomy the emptying of intrathoracic stomach was delayed and improved over time, however, still failed to reach normal one year after surgery. The contracting pressure of the upper esophageal sphincter and resting pressure of the remnant esophagus in the patients undergoing esophagectomy were both higher than those in the normal controls （ both P 〈 0. 05 ） ; there was no significant difference in the intrathoracic pressure between the patients and the controls. In the patients with esophageal cancer no primary peristalsis was detected in the fundus and body of the intrathoracic stomach and the primary esophageal peristalsis induced by swallowing was significantly decreased. However, normal primary peristalsis was detected in the remnant esophagus of the patients with cardiac cancer after surgery. 89. 7% of the patients who had undergone esophagectomy showed gastroesophageal reflux measured by 24- hour pH monitoring. The extent of reflux was lessened when the patients were in a semi - reclining position than in a prostration position. Conclusions After esophagectomy the emptying of intrathoracic stomach is delayed and then improved gradually over time, but still fails to return to normal level. Gastroesophageal reflux extensively exists in the patients undergoing esophagectomy for cancer, but it can be lessened by taking semi - reclining position.