管状胃宽度与食管癌术后抗胃食管反流的相关性研究

Study on the relationship between the tubular gastric width and the anti gastroesophageal reflux after esophageal cancer operation

目的分析管状胃宽度与食管癌术后抗胃食管反流的相关性,为临床食管癌患者手术方式的选择提供参考。方法选择2015年1月至10月在我院接受食管癌根治术联合管状胃重建胃食管治疗的60例患者,根据术中管状胃的吻合途径(颈部吻合、胸腔吻合)及管状胃不同宽度(≥3 cm、<3 cm)进行分组,分别为:颈部吻合+≥3 cm组(14例)、颈部吻合+<3 cm组(15例)、胸腔吻合+≥3 cm组(15例)与胸腔吻合+<3 cm组(16例)。所有患者均于术后第11天开始行24 h食管p H监测,连续监测3 d,指标包括:反流次数、p H<4的累积时间,收集患者术后出现临床症状(烧心、胸痛、咽部异物感、咳嗽、哮喘等)的次数及出现临床症状的时间,所有患者均于术后第14天行内镜检查,观察患者食管黏膜并进行病理组织学胃黏膜炎症分级。将所有出现反流症状患者的管状胃宽度和食管黏膜炎症分级进行相关性分析。结果 4组患者出现反流症状的次数、反流临床症状发生率、p H<4的累积时间差异有统计学意义(P<0.05);颈部吻合+<3 cm组患者出现反流症状的次数、p H<4的累积时间、患者反流临床症状发生率均明显低于其他3组(P<0.05),不同组间内镜下食管黏膜病理组织学炎症分级差异具有统计学意义(P<0.05),颈部吻合+<3 cm组患者食管黏膜炎症分级最轻。出现反流症状患者的管状胃宽度和食管黏膜炎症分级呈线性相关,管状胃宽度增加,食管黏膜炎症分级越严重,反流症状的次数、p H<4的累积时间越高。结论食管癌术后采用管状胃重建胃食管,胃食管的宽度对患者术后出现胃食管反流密切相关,术中因为患者个体原因无法将管状胃宽度控制到合适范围时,应加强患者反流相关指标监测,便于及早采取措施防治胃食管反流,提高患者预后质量。

Objective To analyze the correlation between the tubular gastric width and the anti gastroesophageal reflux after esophageal cancer operation, and to provide reference for the choice of surgical methods in treatment of esophageal cancer. Methods Selected 60 patients who received radical surgery for esophageal carcinoma combined with gastric tube reconstruction surgery in our hospital from January 2015 to October 2015, and divided them into two groups according to the way of stomach tube anastomosis（ cervical anastomosis ,thoracic an- astomosis） and different width of gastric tube （ greater than or equal to or less than 3 cm）. Namely：cervical anastomosis ＋ greater than or equal to 3 cm group（ 14 cases） , cervical anastomosis ＋ less than 3 cm group（ 15 cases）, thoracic anastomosis ＋ greater than or equal to 3 cm group（ 15 cases） and thoracic anastomosis ＋ less than 3 cm group（ 16 cases）. All patients recieved esophageal pH monitoring for 3 days continuously from the 1 l th day after operation. The monitoring indicators include：number of reflux, accumulation time of pH 〈 4, whether there were clinical symptoms （ heartburn, chest pain, pharyngeal foreign body sensation, cough, asthma, etc. ） after surgery, and the frequency and time of these clinical symptoms appeared. All the patients were given endoscopic examination at the 14th days postoperatively. Observed the e- sophageal mucosa of patients and conducted histopathological grading of gastric mucosal inflammation. And then made a correlation analysis of gastric tube width and esophageal mucosal inflammation grade among all the patients with reflux symptoms. Results The cumulative time and number of reflux,incidence rate of clinical symptoms, and pH values less than 4 were significantly different（ P 〈 0.05）. The cumulative time and number of reflux, incidence rate of clinical symptoms, and pH values less than 4 in the cervical anastomosis ＋ less than 3 cm group were significantly lower than that in the other 3 groups （P 〈 0.05 ）, with statistical significance between different groups of endoscopic esophageal mucosa inflammation grade difference （P 〈 0.05 ）. Esophageal mucosal inflammation grading in patients of the cervical anastomosis ＋ less than 3 cm group was the lightest. It showed a linear correlation between the gastric tube width and esophageal mucosal inflammation grading in patients with reflux symptoms. Conclusion Postoperative gastroesophageal reflux is closely related to stomach esophagus width after resection of esophageal carcinoma with tubular stomach reconstruction of stomach esophagus, because it is unable to control gastric tube width to the ap- propriate range. And it should be strengthened in patients with reflux related indicators for monitoring, so as to take measures to prevent gastroesophageal reflux as soon as possible to improve the prognosis of patients with quality.