食管癌切除胃代食管重建术不同术式对患者呼吸功能的影响

Effect of different operation methods of reconstruction of esophagus with gastric tube after esophagus resection due to esophageal carcinoma

目的对比性监测行食管癌切除食管胃主动脉弓下吻合或弓上吻合术治疗的患者的呼吸功能,以指导临床治疗。方法选取行食管癌切除食管胃主动脉弓下吻合术患者(弓下组)20例及弓上吻合术患者(弓上组)20例,分别在术前及术后第1、2、4和7天时,监测其呼吸频率(BR)、血氧饱和度(SpO2)和动脉氧分压(PaO2);在术前及术后第1、2、3个月时,监测其肺活量(VC)、第1秒时间肺活量(FEV1)和最大通气量(MVV)。结果患者术后围术期内各时段的BR均高于术前水平(P<0.05),且术后第7天弓上组BR高于弓下组(P<0.05);SpO2和PaO2在术后围术期各时段均低于术前水平(P<0.05);术后第7天弓上组PaO2低于弓下组(P<0.05);2组VC、FEV1、MVV于术后第1、2、3个月均低于术前水平(P<0.05),而术后第3个月弓上组VC、MVV均显著低于弓下组(P<0.05)。结论食管癌患者在围术期和长期恢复过程中呼吸功能在一定时期内明显减弱,食管胃弓上吻合术后患者的通气功能受到更大程度的抑制。

Objective To compare the effect of intra-areh and supra-arch esophagogastric anastomosis after esophagus resection on respiratory function of patients with esophageal carcinoma. Methods 20 patients with esophageal carcinoma undergoing intra-arch esophagogastric anastomosis （intra-arch group ） and 20 patients undergoing supra-arch esophagogastric anastomosis （supra-arch group） were enrolled in the study. Their breath rate （BR）, SpO2 and PaO2 were detected before operation and on the 1st, 2nd, 4th and 7th day after operation, respectively. Then their vital capacity （VC）, forced expiratory volume in one second （FEV1） and maximal ventilatory volume （MVV） were determined before operation and on the 1st, 2nd, 3rd month after operation, respectively. Results Patients＇ BR on each day after operation was more than that before operation （ P 〈 0.05）, and BR of the patients with supra-arch anastomosis was more than that with intra-arch anastomosis on the 7th postoperative day （ P 〈 0.05）. The patients＇ SpO2 and PaO2 on each postoperative day were lower than that before operation （ P 〈 0. 05）, and PaO2 of the patients with supra-arch anastomosis was lower than that with intra-arch anastomosis on the 7th postoperative day （ P 〈0.05）. VC, FEV1 and MVV in both groups on the 1st, 2nd, 3rd postoperative month were lower than those before operation （ P 〈 0.05 ）. On the 3rd postoperative month, VC and MVV of the patients in supra-arch group were lower than those in intra-arch group （ P 〈 0.05）. Conclusion The respiratory function of patients with esophageal carcinoma undergoing esophagogastric anastomosis is decreased at a certain term of perioperative period and long term of recovery, comparatively the ventilation ability of patients undergoing supra-arch esophagogastric anastomosis is inhibited more greatly.