管状胃与全胃代食管术治疗食管癌的临床疗效观察

Clinical Observation in patients with esophageal cancer after esophagectomy fallowed by gastric tube or whole stomach reconstruction

目的:探讨管状胃代食管手术与全胃代食管术治疗食管癌的临床疗效。方法:分析桂林医学院附属医院心胸外科接受食管癌手术的109例患者的病例资料;按手术方式不同分为管状胃组(A组,56例)和全胃组(B组,53例),另选取健康成年人作为对照组(C组,52例)。比较管状胃组和全胃代食管组患者在术中吻合口位置、术中出血量、手术时间、胃肠减压量、术后胃肠减压时间、胸腔闭式引流管拔除时间、胸腔引流液量、术后并发症发生情况及术后1个月的肺功能等临床指标的差异。应用食管测压、24hpH值检测以及食管胃镜等方法,进行胸胃功能检测。结果:管状胃组患者术后,反流性食管炎等术后并发症的发生率低于全胃组,差异有统计学意义(P<0.05)。管状胃组和全胃组术后胸胃功能较对照组下降,但管状胃组疗效较好,3组相比较差异亦有统计学意义(P<0.05)。结论:不同术式食管癌术后胸胃功能均有不同程度下降,但管状胃代食管术后胸围功能较全胃代食管效果好。

Objective： To investigate the therapeutic effect on patients with resectable esophageal cancer after esophagectomy fallowed by gastric tube or whole stomach reconstruction. Methods： This research retrospectively analysed patients underwent esophagectomy for esophageal cancer in our hospital. Patients were divided into to groups, group A, 56 patients underwent gastric tube esophagectomy; group B, 53 patients underwent whole stomach reconstruction esophagectomy. And 52 healthy adults was chosen as control group C. The clinical indexes such as the level of anas-tomosis, the intraoperative bleeding, operation time, postoperative thoracic drainage and gastroin testinal decompression, drainage tube removal time, postoperative complications and respiratory function 1 months after surgeries in patients of two groups were observed and compared. Results： Patients in group A had lower rate o{ postoperative complications reflux esophagitis than patients in group B. The difference was statistically significant（P〈0.05）. Patients in group A had lower rate of thoracic stomach syndrome than patients in group B. The difference was statistically significant. The thoracic gastric function of group A and group B after surgery decreased compared with group C, but Group B decreased significantly, which were of statistical differences. Conclusion： Different operative methods for esophageal cancer can decline gastric function to some extent after esophagectomy, but the gastric tube is better than the whole stomach reconstruction.