管形胃胃肺比及抗反流作用的临床观察

Clinical observation of the role of stomach-lung ratio and anti-reflux of gastric tube

目的评价食管癌根治术病人同期行管形胃代食管术后胃肺比及抗食管反流的临床价值。方法对51例中段食管癌病人行手术根治,同期予以管形胃弓上重建消化道的资料进行回顾性分析,与常规食管癌根治术后的40例病人资料作比较,重点探讨该术式改善术后抗反流方面的优势。结果实验组和对照组患者均在术后一个月入院复查,用Photoshop CS5软件分析两组患者CT片,发现实验组51例病人胃肺比为3.62%±0.63%,较对照组9.50%±0.79%明显减小,有显著的统计学意义(P<0.05);并对两组患者用答卷方式询问食管反流方面的临床症状、对比两组患者钡餐及胃镜结果,发现实验组的返流程度远低于对照组,临床症状对比P值0.032;钡餐对比P值0.031;胃镜对比P值为0.015,均小于0.05,差距有显著的统计学意义。结论以一次性切缝器制作管形胃,重建上消化道治疗食管癌可减小胃肺比,有效预防或减少反流性食管炎的发生,减少了胃肺比,术后远期生活质量高。

Abstract：Objective To calculate the tomach-lung ratio after esophagectomy for gastric tube construction and evaluate the clinical value of the gastric tube for anti-reflux. Methods A retrospectively analysis was conducted in 51 middle esophageal cancer patients treated with esophagectomy for gastric tube construction, comparing with the normal radical esophagectomy in 40 patients , and to discuss the anti-reflux advantage of the gastric tube. Results The experimental group and control group patients were follow up a month postoperatively, the CT of two groups were assessed with Photoshop CS5, the mean stomach-lung ratio of the experiment group was 3.62% ± 0.63% ,less than 9.50% ± 0.79% in the control group （P 〈 0.05 ）. The clinical symptoms, the esophageal barium meal features and the gastroseopie manifestations of the experimental group were far lower than the control group（ P = 0. 032,0. 031,0. 015 respectively）. Conclusion Gastric tube construction in esophagectomy can reduce stomach-lung ratio, prevent or reduce the reflux esophagitis, im- prove the long-term quality of life.