术后不同消化道重建方法对高龄食管癌患者Barrett食管发生率的影响

Effect of Different Postoperative Digestive Tract Reconstruction Methods on the Incidence of Barrett's Esophagus in Elderly Patients with Esophageal Cancer

目的研究术后不同消化道重建方法对高龄食管癌患者Barrett食管发生率的影响。方法选取142例食管癌高龄患者,随机分为对照组与研究组。两组均行胸腔镜食管癌切除术,对照组术后行传统全胃代食管吻合术进行消化道重建,研究组行管状胃代食管吻合术。比较两组围手术期临床指标、肺功能、生活质量及术后Barrett食管发生率。结果两组术后出血量、手术时间、术后下床时间、住院时间比较无统计学意义(P>0.05);研究组胃肠减压量低于对照组(P<0.05)。术后2个月两组每分钟最大通气量(MVV)、用力肺活量(FVC)、第1秒用力呼出量(FEV1)水平均显著下降,但研究组高于对照组(P<0.05)。术后2个月两组生活质量评分显著上升,且研究组高于对照组(P<0.05)。研究组Barrett食管发生率(2.78%)低于对照组(11.43%)(P<0.05)。结论食管癌术后采取管状胃代食管吻合术行消化道重建能有效改善高龄患者术后症状,提高肺功能及生活质量,预防或减少Barrett食管发生情况,可作为食管癌根治术后首选方案之一。

Objective To investigate the effect of different postoperative digestive tract reconstruction methods on the incidence of Barrett's esophagus in elderly patients with esophageal cancer.Methods A total of 142 elderly patients with esophageal cancer were enrolled,and randomly divided into 2 groups.All patients received thoracoscopic esophagectomy,based on this,the control group received digestive tract reconstruction with conventional full stomach esophagus anastomosis,while the study group received reconstruction with tubular esophagus stomach anastomosis.Then the perioperative clinical indexes,pulmonary function,quality of life and the incidence of Barrett's esophagus were compared between the 2 groups.Results The postoperative bleeding,operation time,first out-of-bed activity time and hospital stay showed no significant difference between the 2 groups(P>0.05).The gastrointestinal decompression volume in study group was lower than that in control group(P<0.05).Two months after surgery,the minute ventilation volume(MVV),forced vital capacity(FVC)and forced expiratory volume in 1 second(FEV1)were significantly decreased in both groups,while the above 3 indicators were higher in the study group than in the control group(P<0.05),meantime,the quality of life score was significantly increased in both groups,and the study group scored higher than the control group(P<0.05).The incidence of Barrett's esophagus was 2.78%in the study group,which was significantly lower than 11.43%in the control group(P<0.05).Conclusion Application of digestive tract reconstruction with esophagus-tubular remnant stomach anastomosis after thoracoscopic esophagectomy for elderly patients can effectively improve the clinical symptoms,pulmonary function,quality of life,and reduce the risk of Barrett's esophagus,which is worthy of promotion.