管胃和全胃重建食管的随机对照研究

Randomized Controlled Study of Esophagectomy with Gastric Tube Reconstruction versus Whole Stomach Reconstruction for Esophageal Cancer Patients

目的:探讨管胃和全胃在食管癌切除术后重建食管临床应用的效果。方法:2006年7月至2008年10月选取四川省肿痛医院随机分组采用管胃和全胃各120例重建食管行食管癌切除术,胸中段和胸下段癌经上腹右胸后外切口径路(Ivor Lewis),胸上段癌经右胸上腹左颈三切口径路。从胃底沿胃小弯至胃窦部距大弯侧4～5cm用切割缝合器缝合切除贲门和胃小弯后制作成管胃,术中测量全胃和管胃的长度。观察手术时间、出血量、输血量、术后胃液引流量、胸液引流量;观察肺炎、吻合口狭窄、胃瘘、吻合口瘘、反流性食管炎,胃排空障碍等并发症,观察进食后的饱胀感和每天的食量,多普勒超声测定胃排空时间。结果:管胃组胃平均延长5～7cm,手术时间、出血和输血未增加,吻合口瘘无明显增加,胃排空障碍、反流性食管炎比全胃组明显减少,彩色多普勒测定的结果表明管胃比全胃通过率快,未出现胃潴留的情况,差异具有统计学意义(P<0.05)。每天的食量,管胃组0.8kg,全胃组0.6kg,进食后早期管胃组消化道舒适,全胃组气紧。结论:管胃重建食管癌切除术符合生理解剖要求,未增加吻合口瘘,管胃比全胃通过率快,每天的进食量增加,减少了胸胃综合征和反流,进食后早期管胃组消化道舒适,无胸闷气紧;可以切除胃小弯淋巴组织,减少肿瘤残留和复发,管胃组并发症的发生率比全胃组少,特别是胃排空障碍和反流发生率比全胃移植低,提高了患者的生存质量。

Objective： To assess the efficacy of esophagectomy with gastric tube reconstruction versusgastric stomach reconstruction for esophageal cancer pateints. Methods： A total of 240 esophageal cancer patientswere randomly divided into Group A （treated with reconstruction with whole stomach, n=120） and GroupB （treated with reconstruction with whole tube, n=120）. Tumors located in the middle third and lower third ofthe esophagus were removed by a combined laparotomy and right thoracotomy （the Ivor lewis approach）. Tumorslocated in the upper third of the esophagus were removed by a combined laparotomy and right thoracotomyand left cervical incision. Gastric tube was made with linear stapler after the cardia and the lesser curveof the stomach were excised. The length of gastric stomach and whole tube were measured during surgery.The duration of surgery, blood loss and blood transfusion were measured. The volume of gastric fluid and thoracicfluid were measured after surgery. Gastric empting time was measured by Doppler sonography. Results：The extension of gastric stomach in Group B was 5-7cm. The duration of surgery, blood loss, blood transfusion,and anastomosis fistulas in Group B were not significantly different from those in Group A. The rate ofdelayed gastric empting and reflux esophagitis in Group B was lower than that in Group A （P〈0.05）. The foodintake was 0.8 kg in Group B and 0.6kg in Group A （P〈0.05）. Patients in Group A complained of dyspnea. Con？clusion： Gastric tube reconstruction fits physiology, with lower rates of anastomosis fistulas, delayed gastricempting and reflux esophagitis. Gastric tube reconstruction is helpful for improving the quality of life of esophagealcancer patients.