重建贲门、胃底预防食管癌术后反流性食管炎的临床价值分析

Clinical significance of reconstruction of gastric cardia and fundus in preventing reflux esophagitis after esophagectomy

目的通过在管胃的基础上重建贲门(人工贲门)、胃底(人工胃底)探讨手术方式对预防食管癌术后胃食管反流的临床效果。方法将73例食管癌患者按手术方式不同分成单纯管胃组(37例)和管胃+抗反流组(36例),分别在术后的1、6、12个月对患者术后的反流症状、上消化道造影、24 h p H值监测及胃镜结果进行比较。结果全组无手术死亡患者。术后反流症状、上消化道造影、胃镜等结果提示管胃+抗反流组与管胃组组间比较差异无统计学意义(P﹥0.05)。两组患者在24 h p H值测定术后1个月、6个月的总反流数,术后1个月、6个月的反流﹥5 min数,术后6个月、1年的p H值﹤4时间比较,差异有统计学意义(P﹤0.05),提示管胃+抗反流组抗反流效果总体优于单纯管胃组。其中管胃+抗反流组无吻合口瘘出现,但吻合口狭窄发生率要高于管胃组(19.4%vs 10.8%)。结论管胃+重建贲门、胃底术式较单纯管胃术式能更好地控制食管癌术后胃食管反流,且降低了术后出现吻合口瘘的风险。

Objective To explore the clinical effect of the reconstructive operation in preventing gastroesophageal re-flux after esophagectomy by reconstructing the cardia （artificial cardia） and gastric fundus （artificial gastric fundus） on the basis of the gastric tube. Method 73 patients with esophageal carcinoma were stratified as control group （with sim-ple gastric tube reconstruction, n=37） and study group （with gastric tube＋anti-reflux surgery, n=36） as per respective sur-geries administered, of which the reflux symptoms, upper gastrointestinal radiograph and 24 h pH as well as gastroscopy findings in 1, 6 and 12 months after surgery were assessed. Result There was no death reported in the cohort. The post-operative reflux symptoms, upper gastrointestinal radiograph and gastroscopy findings were similar between the two groups （P〉0.05）; While significant differences were observed in aspect of incidence of total reflux in 1 month and 6 months, reflux〉5 min in 1 and 6 months, time of pH〈4 in 6 and 12 months after surgery for the two groups （P〈0.05）, sug-gesting a better overall response in study group than that that of the control group. The study group had no anastomotic leakage, but was of higher incidence of anastomotic stenosis than that of control group （19.4% vs 10.8%）. Conclusion Gastric tube reconstruction of gastric cardia and fundus is superior than simple gastric tube recontruction in controlling the gastroesophageal reflux, which may reduce the risk of anastomotic leakage after reconstructive surgery.