食管纵隔胃颈部吻合术后食管胃的压力监测及评价

Manometric study of residual esophagus and stomach after subtotal esophageal resection and cervical gastroesophagostomy

目的检测食管癌切除食管、纵隔胃颈部吻合术后病人残余食管及胃的功能。方法采用国产SG-III型消化道压力检测仪对21例食管癌切除食管纵隔胃颈部吻合术后病人进行消化道压力检测,并与25名正常人测定值对照。结果术后病人咽部的静息压力为(1·20±2·03)mmHg(1mmHg=0·133kPa),收缩压为(72·37±16·95)mmHg;食管上括约肌的静息压力为(28·20±15·60)mmHg,关闭压为(107·10±28·43)mmHg;吻合口上方食管的静息压力为(15·98±11·10)mmHg,收缩压为(48·45±18·37)mmHg;胃的静息压力(3·53±3·30)mmHg,食管原发性蠕动的发生率为(57·14±34·50)%。其中吻合口上方食管的静息压力值明显高于正常成人(5·63±8·78)mmHg,差异有统计学意义(P<0·01)。结论食管癌切除食管胃颈部吻合术后,在吻合口上方的食管产生了新的压力区。该压力的形成与吻合时胃上提包套残余食管及颈部肌群等软组织共同对食管所造成的压力有关,具有一定的抗反流作用,食管胃颈部吻合的术式具有更好的减轻术后胃食管反流的作用,能改善病人术后生活质量。

Objective To evaluate the function of residual esophagus and stomach after subtotal esophagectomy and cervical gastroesophagostomy for esophageal eareinoma. Methods Manometry was performed in 21 patients who underwent cervical anastomosis after subtotal esophageal resection. The data was compared with normal subjects. Results The mean value d pharyngeal resting Pressure was （1.20±2.03）mm Hg（1 mmHg=0.133 kPa）, and that of contraction pressure was （72.37± 16.95） mmHg. The resting pressure of upper esophageal sphincter （UES） was （28.20± 15.60） mmHg, and dosing pressure was （ 107.10± 28.43） mmHg. The resting pressure of residual esophagus was （15.98± 11.10）mmHg, and contraction pressure was （48.45±18.37）mmHg. The resting pressure of stomach was （3.53±3.30）mmHg. Incidence of primary wave of esophagus was （57.14±34.50）%. The resting pressure of residual esophagus was much higher thaa that of normal normal group （p〈0.01）. Conclusion Manometric study showed that thereisa new pressure zone in the residual esophagus. This pressure zone decreased gastroesophageal reflux and improved postoperative symptoms and quality of life. The formation of this pressure zone is correlated with invagnation of stomach and pressing of soft tissue of neck to residual esophagus after subtotal esophagectomy combined with cervical anastomosis.