食管癌贲门癌术后酸反流与十二指肠胃食管反流

Acid reflux and duodeno-gastro-esophageal reflux after esophagectomy for cancer

目的探讨食管癌和贲门癌术后酸反流和十二指肠胃食管反流（DGER）的相互关系、反流特征以及对食管黏膜的损伤作用。方法对32例食管癌和贲门癌术后病人进行烧心、反酸症状调查，应用电子胃镜检查、24h食管pH和胆红素同步监测。结果（1）胃食管反流症状的发生率65．6％，反流性食管炎的发生率为75．0％，其中2例发生Barrett食管，发生率为6．25％。（2）24h食管pH和胆红素监测结果显示，28．1％的病人仅存在酸反流，15．6％仅存在DGER，53．1％同时有酸反流和DGER。DeMeeste评分与abs〉0．14的时间百分比无明显的相关性（P=0．3109）。平卧位pPI〈4．00的时间百分比和abs〉0．14的时间百分比明显高于直立位（P〈0．05）。（3）通过比较在不同pH区间内胆红素的吸收率，显示在pH3～6的区间内，胆红素abs〉0．14的时间百分比明显高于其他区间（P〈0．05）。（4）DeMeester评分和胆红素abs〉0．14的时间百分比与反流症状评分无明显的相关（P〉0．05），与反流性食管炎评分呈正相关（P〈0．05）。结论食管癌和贲门癌术后存在广泛的酸反流和DGER，反流形式以混合性反流为主（同时出现酸反流和DGER），混合性反流对食管黏膜的损伤作用更严重。酸反流和DGER均受体位影响。24h食管pH和胆红素同步监测有助于揭示反流特征及反流物对食管黏膜的损伤作用。

Objective Investigate the effect of acid reflux and duodenogastroesophageal reflux （DGER） on damage to remnant esophageal mucosa after esophagectomy. Methods Questionnair of gastroesophageal symptorhs, endoscopy and twenty-four hour pH and spectrometric bilirubin monitoring of the esophagus were performed in thirty-two patients who underwent esophagectomy for their cancer. Results The incidence of postoperative reflux symptom was 65.6%. The incidence of reflux esophagitis was 75.0%. Barrett esophagus was observed in 2 patients （6.2%）. 28. 1% of patients had only acid reflux. 15.6% patients had only DGER. 53.1% of patients had both acid reflux and DGER by analysis of acid reflux and DGER profile. No correlation was found between DeMeester score and fraction time of bilirubin abs 〉 0. 14 （ P = 0.3109 ）. Fraction time of pH 〈4.00 and fraction time of bilirubin abs 〉0.14 in supine position were significantly higher than that in upright position （P 〈 0.05 ）. Most esophageal bilirubin exposure occurred in the range of pH 3 - 6 by moment-moment comparison of pH and bilirubin absorbance. There was no correlation among DeMeester score, fraction time of abs 〉 0.14 and score of reflux symp- toms （P 〉 0. 05 ）, while positive correlation was significant among DeMeester score, fraction time of abs 〉 0.14 and score of reflux esophagitis（ P 〈 0.05 ）. Conclusion Acid reflux and DGER is common pattern after esophagectomy for cancer. Acid reflux and DGER occur simultaneously in the majority of the reflux episodes. The simultaneous acid reflux and DGER is responsible for the severity of injury of esophageal mucosa. The extent of both acid reflux and DGER is influenced by change of body position. Combined ambulatory twenty-four hour pH and spectrometric bilirubin monitoring DGER is useful of analysis of the pattern of reflux and the effect of injury for the esophageal mucosa by acid and duodenal contents.