全胃切除术后食管反流的临床特点分析

Clinical characteristics of esophageal reflux after total gastrectomy

目的观察全胃切除术后食管反流(ERATG)的临床特点,初步探讨其发生机制。方法前瞻性观察14例因胃癌接受全胃切除术后患者的反流症状,同时行24 h食管多通道腔内阻抗联合pH监测,分析患者术后反流的特点。结果全胃切除术后患者均有不同程度的ERATG,主要症状为烧心、食欲不振、胸内闷胀和嗳气。全胃切除术后患者总体ERATG性质以弱酸性物质反流为主,多数反流物4.0<pH<7.0。ERATG的方向自下而上,主要累及范围为食管空肠吻合口及其以上7 cm食管。有典型反流症状的患者直立位反流物pH最低值低于无典型症状患者[(4.76±0.71)比(5.68±0.37),t=2.866,P<0.05];有典型反流症状患者的液体和液气混合反流物反流频次高于无典型症状患者[液体为(31.25±29.76)比(4.50±9.14),t=0.011,P<0.05;液气混合为(19.50±12.99)比(2.00±2.61),t=0.004,P<0.05]。结论全胃切除术后ERATG多为自下而上的弱酸性气体反流,主要症状为烧心、食欲不振、胸内闷胀和嗳气,有典型症状患者的直立位pH值较无典型症状患者更低。

Objective To observe the clinical characteristics of esophageal reflux after total gastrectomy(ERATG),and to explore the mechanism of occurrence.Methods Fourteen gastric cancer patients who underwent total gastrectomy were prospectively enrolled in this study.The postoperative symptoms were observed and recorded and 24 h MII-pH with pH monitoring was performed to investigate the characteristics of postoperative reflux.Results After total gastrectomy patients were with different degrees of ERATG as heartburn,appetite loss,chest tightness and belching.The overall nature of ERATG is mainly weak acid,with a pH between 4 and 7.ERATG involved esophageal-jejunal anastomosis and a length of esophagus 7 cm above the anastomosis.Patients with typical reflux symptoms had a lower pH minimum in the upright position than those without typical symptoms[(4.76±0.71)vs.(5.68±0.37),t=2.866,P<0.05].Patients with typical reflux symptoms had a higher frequency of reflux of mixed liquid and liquid-air reflux than those without typical symptoms[liquid(31.25±29.76)vs.(4.50±9.14),t=0.011,P<0.05;liquid-air(19.50±12.99)vs.(2.00±2.61),t=0.004,P<0.05].Conclusion ERATG is mainly a upward reflux of weakly acidic gas,with typical symptoms of heartburn,appetite loss,chest tightness and belching.Patients with typical symptoms usually have lower pH in the upright position.