幽门成形联合十二指肠韧带松解对预防贲门癌术后胃食管返流的影响

Combined pyloroplasty and amputation of the ligament of Treitz in preventing postoperative gastroesophageal reflux after operation for cancer of gastric cardia

目的评价幽门成形联合十二指肠韧带松解在预防贲门癌术后返流中的临床效果。方法将22例贲门癌近端胃切除患者术中行幽门成形联合十二指肠韧带松解作为A组,另选未行幽门成形联合十二指肠韧带松解的18例贲门癌手术患者作为B组对照,通过术后进行食管24hpH监测,电子胃镜检查评价抗返流效果。结果通过比较40例贲门癌近端胃切除手术患者不同术式两组间24hpH监测参数显示:24h酸返流的总的返流次数、长于5min的返流次数两组间差异无统计学意义(P>0.05);而A组的pH<4.00的总时间以及最长返流的时间明显低于B组,两组间差异有统计学意义(P<0.05)。A组返流性食管炎评分明显低于B组(P<0.05)。结论综合抗返流术式方法简便,临床抗返流效果好。

Objective To investigate the results of combined pyloroplasty and amputation of the ligament of Treitz in preventing gastroesophageal reflux after operation for cancer of gastric cardia. Methods Fourty patients were randomly divided into 2 groups： group A , 22 patients who had undergone proximal gastroctemy and received anti-reflux surgery, and group B, 18 patients who had received no anti-reflux procedures. The results were evaluated using endoscopy and 24 hour-PH monitoring. Results Comparing the results of 24-hour PH monitoring of the 40 patients after proximal gastrectomy showed no significant difference in the number of reflux episodes of pH 〈 4.00 and the number of reflux episodes 〉 5 minutes between the two groups. The total fraction of reflux episodes of PH 〈 4.00 in group A was significantly lower than that in group B （P 〈 0.05）. The score of reflux esophagitis in group A was lower than that in group B（P 〈 0.05）. Conclusion The anti-reflux technique is simple and its clinical result is better.