结肠代食管术后移植段结肠运动的变化

Changes of Motor Activity in Interposed Colon after Colon Replacement of Esophagus

目的评价结肠代食管术后移植段结肠的运动变化。方法应用上消化道动力监测仪对10例行结肠代食管术的食管癌患者分别在静息、干咽、湿咽的不同状态下进行移植段结肠腔内测压,并结合术后胃肠功能等级评定对不同移植方向的结肠功能进行比较。结果全组共记录到低幅非推进性收缩16次,高幅非推进性收缩13次,低幅推进性收缩21次,高幅推进性收缩23次。湿咽较干咽食管收缩波更易通过吻合口向移植段结肠传导,并诱发结肠的继发性收缩波。移植段结肠推进性收缩波的方向取决于结肠移植的方向。结肠顺蠕动移植的患者术后胃肠功能等级评定优于结肠逆蠕动移植的。结论移植段结肠存在着稳定和匀质的收缩。结肠代食管术中应力争行结肠顺蠕动移植。

Objective To evaluate motor activity of grafted colon in esophageal subtitute. Methods In 10 cases of colon replacement of esophagus, manometric studies were carried out when the colon grafts 6 12 months after operation subjected to the follow situation： quiescent state, dry swallow, swallowing of 30 mL distilled water. Results Colonic constraction were 16 for low amplitutle non-propelling contraction （LANPC）, 13 for high antplitule non-propelling pevistalsis（HANPC）, 21 for low amplitute propelling contraction（LAPC） and 23 for high amplitute propelling contraction（HA_PC）. The migrating contractive waves could transmit from esophagus to colon segment by wet swallowing and easily induced secondary contrative waves on grafted colon. The motor activity of the grafted colon after wet swallowing was significantly higher than that after dry swallowing. Esophageal function in grafted colon segments with orthoperistaltic anastonosis fashion was better than that with reversed peristaltic anastomosis fashion. Conclusion Colonic contrative waves are constant and homogeneous and colon interposition should been tried best to place in an isoperistaltie fashion.