不同术式对食管癌术后食管反流的影响

Effects of different surgical methods for esophagectomy on esophageal reflux after esophageal cancer surgery

目的分析不同术式对食管癌切除术后胃食管反流的影响。方法按照不同的手术方式将126例行食管癌手术的患者,分为胸腹腔镜或胸腔镜辅助手术(VATS)组(n=46)、经右胸上腹手术(Ivor-Lewis)组(n=38)、经左胸手术(Sweet)组(n=42)。VATS组和Ivor-Lewis组采用管状胃进行吻合,Sweet组采用全胃缝缩进行吻合,三组均采用吻合器行食管胃端侧吻合。术后行食管腔内24h pH值监测,比较和分析三组患者反流次数、反流超过5min次数、最长反流时间和pH值<4.0的总时间之间的差异。结果三组患者的反流次数、反流超过5min次数、最长反流时间和pH值<4.0的总时间比较差异均有统计学意义(F=7.853,P<0.05;F=6.428,P<0.05;F=12.785,P<0.05;F=10.425,P<0.05),反流发生程度为Sweet组>Ivor-Lewis组>VATS组。结论食管癌手术消化道重建后均存在食管反流现象,采用管状胃并行颈部吻合后,可有效减轻反流症状,改善术后生活质量。

Objective To investigate the effects of different surgical methods for esophagectomy on gastroesophageal reflux after esophageal cancer surgery.Methods One hundred and twenty-six patients with esophageal cancer undergoing esophagectomy by different surgical methods were divided into video-assisted thoracic surgery（VATS）group（n=46）,Ivor-Lewis group（n=38）and Sweet group（n=42）.Tubular stomach anastomosis was conducted in VATS group and Ivor-Lewis group,full stomach sewn anastomosis was carried out in Sweet group,and esophageal stomach stapling side anastomosis was performed in three groups.Esophageal 24 hpH monitoring was done after operation.The reflux episode,number of reflux more than 5min,longest reflux time and total time of pH less than4.0 were compared among three groups.Results There were significant differences in the reflux episode,number of reflux more than 5min,longest reflux time and total time of pH less than 4.0among three groups（F=7.853,P〈0.05;F=6.428,P〈0.05;F=12.785,P〈0.05;F=10.425,P〈0.05）.The degree of reflux：Sweet group〉Ivor-Lewis group 〉VATS group.Conclusions Esophageal reflux occurs after digestive tract reconstruction of esophageal cancer surgery,and can be effectively relieved by tubular stomach anastomosis.