不同平面胃食管吻合术后食管腔内24小时pH监测

Intraesophageal 24hour pH Monitoring after Esophagogastrostomy at Different Levels

目的为了解食管癌、贲门癌切除术后胃食管在颈部、弓上和弓下吻合术后发生胃食管反流的差异。方法对１０例正常人和３０例在３个不同平面作胃食管吻合的患者术后１～３月进行残留食管腔内连续２４小时ｐＨ监测。结果（１）食管癌、贲门癌患者术后无论吻合平面位于何处，术后近期内２４小时食管腔内ｐＨ各项监测指标均高于正常（Ｐ＜０．０１）；（２）２４小时总反流次数在３个不同吻合平面吻合术间无差异（Ｐ＞０．０５）；（３）其余监测指标颈部吻合＞弓上吻合＞弓下吻合（Ｐ＜０．０１）。结论食管癌、贲门癌患者术后普遍存在胃食管反流现象。吻合平面越高，反流越严重。降低吻合平面，缩小胸胃体积有利于减少术后反流，提高生活质量。

Objective To study the difference of the gastroesophageal reflux(GER) after resection of esophageal or cardiac cancer with esophagogastrostomy performed at the neck, above or below the aortic arch. Methods Intraesophageal 24hour pH monitoring were carried out in 10 normal persons and 30 patients with esophageal or cardiac cancer 1-3 month after radical resection who had no anastomotic stenosis. Results The results revealed that:(1) All of the GER parameters in 30 cases were higher than those of the normal subjects(P<0.01).(2)Frequency of reflux within 24 hours were no significant differences in three levels.(3)The higher the anastomotic level, the more serious GER. Conclusion GER is a common sequela after esophagogastrostomy. The higher the anastomosis is, the more serious the GER. The authors believe manual anastomosis often used now couldn't decrease GER. But reduced that leaving a lower anastomotic level and reducing the bulk of stomach in the thorax could decrease the degrees of GER and improve the quality of life.