两种吻合术式对进展期SiewertⅡ型AEG病人术后胃排空的影响

Effects of two anastomosis methods on postoperative gastric emptying in patients with advanced SiewertⅡAEG

目的:探讨食管窄管胃吻合与传统远半胃吻合术两种吻合术式对进展期SiewertⅡ型食管胃结合部腺癌(AEG)病人术后胃排空的影响。方法:选择择期行手术治疗的进展期SiewertⅡ型AEG病人56例,按照吻合术式分为窄管胃吻合组(n=26)和远半胃吻合组(n=30)。比较2组手术指标、术后恢复情况、术后并发症、病理学检查结果及手术前后营养状况变化,术后2~3个月采用^(99m)Tc-DPTA检查胃排空情况。结果:2组手术时间、术中出血量、十二指肠营养管时间和住院时间差异均无统计学意义(P>0.05);窄管胃吻合组留置引流管时间和术后禁食时间均明显短于远半胃吻合组(P<0.01)。2组术后并发症及术后肿瘤T分期、N分期、TNM分期、肿瘤分化程度差异均无统计学意义(P>0.05);窄管胃吻合组反酸反流评分明显低于远半胃吻合组(P<0.01),使用抑酸剂例数少于远半胃吻合组(P<0.05)。2组手术前后血清前白蛋白、血红蛋白(HGB)、白蛋白(ALB)水平差异均无统计学意义(P>0.05);术后窄管胃吻合组HGB、ALB均低于术前(P<0.05),远半胃吻合组HGB明显低于术前(P<0.01)。窄管胃吻合组术后胃半排时间明显短于远半胃吻合组(P<0.01),5、10、20 min排空率均高于远半胃吻合组(P<0.05~P<0.01),胃排空延缓例数少于远半胃吻合组(P<0.05);2组1、2 h排空率差异均无统计学意义(P>0.05)。结论:进展期SiewertⅡ型AEG病人采用食管窄管胃吻合术后胃排空明显快于传统远半胃吻合术,有利于术后进食及减少术后胃食管反流。

Objective:To investigate the effects of esophageal narrow tube gastric anastomosis and traditional distal hemigastric anastomosis on postoperative gastric emptying in patients with advanced SiewertⅡadenocarcinoma of esophagogastric junction(AEG).Methods:A total of 56 patients with advanced SiewertⅡAEG scheduled for surgery were selected and divided into narrow tube gastric anastomosis group(n=26)and distal hemigastric anastomosis group(n=30)according to the anastomosis methods.The operative indexes,postoperative recovery,postoperative complications,pathological findings and nutritional changes before and after operation were compared between the two groups,and ^(99m)Tc-DPTA was used to examine the gastric emptying at 2 to 3 months after surgery.Results:There was no significant difference in operation time,intraoperative bleeding,nutrition tube time of duodenum and hospital stay between the two groups(P>0.05).The time of indwelling drainage tube and postoperative fasting in narrow tube gastric anastomosis group were significantly shorter than that in distal hemigastric anastomosis group(P<0.01).There was no significant difference in postoperative complications,T stage,N stage,TNM stage and tumor differentiation between the two groups(P>0.05),the acid reflux score in narrow tube gastric anastomosis group was significantly lower than that in distal hemigastric anastomosis group(P<0.01),and the number of cases using acid inhibitors was less than that in distal hemigastric anastomosis group(P<0.05).There was no significant difference in the levels of serum prealbumin,hemoglobin(HGB)and albumin(ALB)between the two groups before and after operation(P>0.05),the level of HGB and ALB in narrow tube gastric anastomosis group was lower than that before operation(P<0.05),and the level of HGB in distal hemigastric anastomosis group was significantly lower than that before operation(P<0.01).The half time of gastric emptying in narrow tube gastric anastomosis group was significantly shorter than that in distal hemigastric anastomosis group(P<0.01),the 5 min emptying rate,10 min emptying rate and 20 min emptying rate were higher than those in distal hemigastric anastomosis group(P<0.05 to P<0.01),the number of cases with delayed gastric emptying was less than that in distal hemigastric anastomosis group(P<0.05),and there was no significant difference in 1 h emptying rate and 2 h emptying rate between the two groups(P>0.05).Conclusions:The gastric emptying of patients with advanced SiewertⅡAEG after esophageal narrow tube gastric anastomosis is significantly faster than that of traditional distal hemigastric anastomosis,which is beneficial to postoperative feeding and reducing postoperative gastroesophageal reflux.