管形胃代食管在食管癌切除术中的临床应用

Clinical Application of Gastric Tube in Reconstruction of Alimentary Tract after Esophageal Cancer Resection

目的探讨管形胃在食管癌切除术中的临床应用及对术后生活质量的影响。方法2007年8月-2008年8月同期对比40例管形胃组和40例传统手术组术后并发症的情况,术后消化道症状和用药的情况及胃镜、钡餐复查的情况。管形胃组切除胃贲门部及胃小弯侧,原位移植入食管床替代切除的食管,与食管残端吻合治疗胸段食管癌。结果全组无死亡,无吻合口瘘发生,管胃组术后早期心肺并发症较对照组明显减少;术后随访6月管胃组与对照组比较无严重的吻合口狭窄、胸胃综合症及明显的反流性食管炎,服用消化道动力药和制酸剂的量和时间较对照组明显减少。结论采用本术式重建消化道更符合生理解剖的要求,在保证肿瘤切除率的同时,明显减少术后近远期并发症的发生,提高了患者的生活质量。

Objective To evaluate the feasibility of clinical application of gastric tube in reconstruction of esophageal cancer resection and its impact on life quality after the operation. Methods From August 2007 to August 2008,80 patients with esophageal cancer were divided equally into two groups, in test group, gastric tube was applied and in control group the whole stomach was substituted for the esophagus. The operative complications, alimentary canal symptoms, medication and the results of gastroseope and barium meal after operation were compared between the two groups. The gastric tube group was created by means of cutting off the cardiac portion and lesser gastric curvature. Then the gastric tube was trartsplanted through the esophageal bed to make an anatomosis with the proximal esophageal stump. Results There were no decease and stoma-fistula in two groups. The incidence of heart and lung complications during earlier period of post-operation was significantly decreased in test group; there were no severe stomach angusty, disturbance of thoracic gastric syndrome and severe reflux esophagitis detected in the two groups during 6 month follow up. The dose and frequency of taking the digestive dynamic medicines and antiacids significantly decreased in test group. Conclusion The gastric tube is a reliable graft in alimentary tract reconstruction, the incidence of short and long-term complications significantly decreased, patients＇ life quality can be improved.