两种弓上食管胃吻合术后胃食管反流的比较

Postoperative gastroesophageal reflux status comparative in two upon aortic arch methods esophagogastrostomy

目的比较食管癌手术行"隧道式"式和器械式两种经主动脉弓上食管胃吻合方式术后胃食管反流的状况。方法对两组患者,"隧道式"吻合术组21例,器械吻合方式组35例,术后3个月行24 h食管pH监测;胃镜检查反流性食管炎的程度,并进行分级和评分。结果24小时pH监测显示,两组各项指标均高于正常值,但隧道组各项指标均低于器械式吻合组,差异有统计学意义:DeMeester评分和超过5 min的反流次数、pH低于4的总时间、以及pH<4的时间百分数(P<0.01)、24 h反流的次数和最长的反流时间(P<0.05);胃镜检查结果显示:器械组反流性食管炎的发生率为65.7%(23/35),明显高于隧道组为38.1%(8/21),两组反流性食管炎分级及反流性食管炎评分比较差异有统计学意义(P<0.01),器械组高于隧道组。结论两种吻合方式术后均有胃食管反流,弓上隧道式食管胃吻合术患者术后反流性食管炎的发生率和反流程度均小于器械吻合术式。

Objective To comparative esophageal carcinoma patients＇gastroesophageal reflux（GER） status after tunnel and appliance esophagogastrostomy upon the aortic arch.Methods After operation 3 months,the two groups,tunnel group（21case） and appliance group（35case）,were monitored by 24hour esophageal pH monitoring and examined by electrogastroscope.Results All of the pH monitoring values in the two groups was higher than the reference value of normal.Comparing the two groups,there were significant differences in the five pH monitoring indexes：DeMeester Score（P〈0.01）,number of reflux（P〈0.05）,number of long reflux（min）（〉5 min,P〈0.01）,duration of longest reflux（min）（P〈0.05）,time pH〈4（min）（P〈0.01）,fraction time pH〈4（%）（P〈0.01）and esophagitis grade between tunnel group and appliance group（P〈0.01）.Conclusion After the operation of esophagogastrostomy,GER exists objectively.The tunnel esophagogastrostomy upper the aortic arch is prefer to the appliance in reducing the extent and ratio of GER.