经食管床胃食管吻合术后胃食管反流与胃排空的临床研究

Clinical Study of Gastroesophageal Reflux and Gastric Emptying after Esophagectomy with Gastric Replacement Through Esophageal Bed

目的客观评价食管中段癌切除经食管床主动脉弓上胃食管吻合术对术后胃食管反流和胃排空的影响。方法将40例食管中段癌患者随机分成两组,食管床吻合组(n=20):采用经食管床主动脉弓上胃食管吻合术;左胸腔内吻合组(n=20):采用经左侧胸腔主动脉弓前胃食管吻合术;另选10名无消化系统疾病的健康志愿者作为正常对照组。于术后3个月进行24h食管pH监测,放射性核素胃排空检查,观察术后胃食管反流和胃排空情况。结果所有患者手术均成功,无手术死亡,术后无吻合口漏和狭窄。术后3个月左胸腔内吻合组和食管床吻合组患者均有不同程度的反流,DeMeester总评分、24h酸反流次数、>5min的反流次数、最长反流持续时间、pH<4.00的总时间和pH<4.00占总时间的百分比均高于正常对照组(P<0.01);食管床吻合组DeMeester总评分、24h酸反流次数、最长反流持续时间、pH<4.00的总时间、pH<4.00占总时间的百分比均低于左胸腔内吻合组(P<0.01)。术后近期各时间段左胸腔内吻合组和食管床吻合组胃排空百分数(GE)均较正常对照组低(P<0.01);食管床吻合组GE于实验餐进入胃后30、60、90、120、180和240min均高于左胸腔内吻合组(P<0.01)。结论经食管床主动脉弓上吻合术后胃食管反流和胃排空延迟客观存在,但较传统手术方式有所减轻,其机制可能是机械因素所致。

Objective To evaluate the effect on gastroesophageal reflux and gastric emptying in the different route of gastroesophageal anastomosis objectively after esophagectomy for patients with mid-esophageal carcinoma. Methods Forty patients with mid-esophageal carcinoma were randomly divided into two groups. Esophageal bed group （n=20）： the gastroesophageal anastomosis were performed while the stomach were pulled on through the esophageal bed after esophagectomy; endothoracic group （n= 20）： gastroesophageal anastomosis were performed while the stomach were pulled on in the thoracic cavity. Ten persons had no disease of digestive system and healthy volunteers were recruited as normal control group. 24-hour esophageal pH monitoring and radioisotope gastric emptying check-up were carried out in all experimental subjects 3 months after operation, so as to observe the changes of gastroesophageal reflux and gastric emptying. Results All of the patients＇s operation were success. And no anastomotic leakage and no anastomotic stenosis. Three months after operation, the patients in both operation groups were with different level of reflux. DeMeester total appraise score, the times of regurgitation of gastric juice in 24h, 〉5 min reflux frequency, the longest time of keep reflux, pH〈4. 00 total time and ph〈4.00 of total time percent, these targets in both operation groups were higher than those in control group （P 〈0. 01） DeMeester total appraise score, the times of regurgitation of gastric juice in 24 hours, the longest time of keeping reflux, pH〈4.00 of total time and pH〈4.00 of total time percent in esophageal bed group were lower than those in endothoracic group （P〈0.01）. The recent period of gastric emptying percentage （GE） in both operative groups were lower than that in normal control group. GE in esophageal bed group experimental meal in the stomach after entering the 30,60,90,120,180 and 240 min were higher than those in endothoracic group. Conclusion After the operation of esophagogastric anastomosis through esophageal bed in upper aortic site, gastroesophageal reflux and delayed gastric emptying exist objectively, However, the technique is superior to the traditional technique to reduce the extent of gastroesophageal reflux and delayed gastric emptying, its mechanism might be the result of mechanical factors.