间置空肠肌黏膜瓣成形在贲门癌术后抗反流中的应用

Clinical use of interposed jejunum and musculomucosal valve plasty in anti-gastroesophageal reflux after cardiac cancer eradication

目的 寻找一种能有效对抗贲门癌术后反流性食管炎的消化道重建术式。 方法 将 6 2例贲门癌患者分为两组 ,实验组 :30例 ,贲门癌手术采用间置空肠附加肌黏膜瓣成形消化道重建 ;对照组 :32例 ,采用“常规”食管 -残胃套叠吻合。应用同位素测定胃食管反流指数 ,2 4小时食管 p H监测及临床反流症状评定方法进行对比分析。 结果同位素胃食管反流指数测定显示 ,实验组反流阳性率为 0 % ,对照组为 93.33%。 2 4小时食管 p H测定显示 ,实验组Demeester评分为 2 .0 1± 2 .2 1,对照组为 10 3.4 0± 91.35 ,两组比较差别具有显著性意义 (P<0 .0 1)。反流临床症状评定结果实验组无 1例出现反流症状 ,而对照组 2 4例 (75 % )出现反流症状。 结论 间置空肠肌黏膜瓣成形术式具有优异的抗反流功效 ,能有效地防止贲门癌术后反流性食管炎的发生。

Objective To seek an ideal method of alimentary tract reconstruction that can effectively resist gastroesophageal reflux (GER) after cardiac cancer eradication. Methods Sixty-two patients with cardiac cancer were divided into the following two groups: experimental group consisted of 30 patients in which the reconstruction was performed using interposed jejunum and musculomucosal valve plasty, and control group of 32 patients in which the reconstruction was routinely performed using invaginated esophagogastrostomy. Isotope gastroesophageal reflux index (GERI), the 24 h esophageal pH records and clinical reflux symptom scores were compared in two groups. Results Isotope GERI showed that the reflux positivity rate was 0% in experimental group, and 93.33% in control group. There were significant differences in the two groups (P<0.01). The 24 h esophageal pH records indicated that Demeester score was 2.01±2.21 in experimental group, 103.40±91.35 in control group, and there were also considerable differences in the two groups (P<0.01). The clinical reflux symptom scores found that there was no GER in experimental group, but in the control group there was GER in 24 patients(75%). Conclusion The interposed jejunum and musculomucosal valve plasty has anti-reflux effect and can prevent regurgitational esophagitis after cardiac cancer eradication.