圆锥形胃残端套叠包埋在食管癌根治术中抗反流的临床研究

Clinical study on anti-reflux of conical gastric stump embedding in radical resection of esophageal cancer

目的 研究圆锥形胃残端套叠包埋在食管癌根治术中抗反流的临床效果。方法 选取2020年6月至2022年6月于我院拟行食管癌根结术的60例患者为研究对象,采用随机数字表法将患者分为观察组和对照组,各30例。2组患者均行腔镜食管癌根治术并行食管-胃端侧机械吻合,观察组行食管-胃端侧机械吻合后,采用圆锥形胃残端套叠包埋技术。比较2组患者围术期相关指标、术后并发症及胃食管反流情况。采用反流性疾病问卷(RDQ)评分和食管内24 h pH监测评估术后抗反流效果。结果 观察组患者手术时间、消化道重建时间均长于对照组(P<0.05),而2组患者术中出血量、淋巴结清扫数量、首次排气时间及术后住院时间比较,差异均无统计学意义(P>0.05)。2组术后并发症总发生率比较,差异无统计学意义(P>0.05);观察组患者术后胃食管反流的严重程度较对照组轻,差异有统计学意义(P<0.05)。观察组患者RDQ评分、24 h反流次数、>5 min反流次数、pH<4时间及最长反流时间均明显低/少/短于对照组(P<0.05)。结论 圆锥形胃残端套叠包埋技术应用于食管癌根治术中安全可行,虽手术时间及消化道重建时间略有延长,但并未增加围术期相关风险,可明显减少患者术后胃食管反流的发生,并减轻了其严重程度,具有较好的抗反流作用。

Objective To study the anti-reflux effect of conical gastric stump embedding in radical resection of esophageal cancer.Methods A total of 60 patients who planned to undergo radical resection of esophageal cancer in our hospital from June 2020 to June 2022 were selected as the study objects,and the patients were divided into the observation group and the control group by random number table method,with 30 cases in each group.Patients in both groups underwent laparoscopic radical resection of esophageal cancer and esophagogastric end-to-side mechanical anastomosis.The observation group adopted the conical gastric stump embedding technique after esophagogastric end-to-side mechanical anastomosis.The perioperative related indexes,postoperative complications and gastroesophageal reflux of patients in the two groups were compared.The postoperative anti-reflux effect was evaluated by reflux disease questionnaire(RDQ)score and 24-hour intraesophageal pH monitoring.Results The operation time and digestive tract reconstruction time of patients in the observation group were longer than those in the control group(P<0.05),while there was no statistically significant difference in the amount of intraoperative bleeding,the number of lymph node dissection,the first exhaust time,or the postoperative hospital stay of patients between the two groups(P>0.05).There was no statistically significant difference in the overall incidence of postoperative complications between the two groups(P>0.05).The severity of postoperative gastroesophageal reflux of patients in the observation group was lighter than that in the control group,and the difference was statistically significant(P<0.05).The RDQ score,24-hour reflux frequency,>5 minutes reflux frequency,pH<4 time,and longest reflux time of patients in the observation group was significantly lower/less/shorter than those in the control group(P<0.05).Conclusion The conical gastric stump embedding technique is safe and feasible in the radical resection of esophageal cancer.Although the operation time and digestive tract reconstruction time are slightly prolonged,it does not increase the perioperative risks,which can significantly reduce the occurrence and severity of postoperative gastroesophageal reflux of patients,and achieve a good anti-reflux effect.