切除食管癌两种消化道重建方式术后胃食管反流的对比 …

目的：探讨食管癌切除后胃经食管床和经胸作弓上吻合者术后发生胃食管反流的差别。方法;对２５例病人在术后１－３个月进行了残留食管内的２４小时ＰＨ监测。结果：（１）两种消化道重建方式病人的ＰＨ总得分,２４小时的总反流次数,〉５分钟的反流次数,最长反流时间和ｐＨ〈４的总时间均超出正常范围。（２）将食管床组和胸内组相比较,２４小时总反流次数差异无显著性,而其余４项指标食管床明显低于胸内组。     

贲门癌术后近期24小时食管pH监测

为了解贲门癌切除术后患者胃食管反流的具体情况,探讨现行手术方法对胃食管反流的影响,评价体位改变对减少胃食管反流的效果,作者对３０例贲门癌患者在术后１３～１８天进行了２４小时食管ｐＨ监测。结果显示：（１）贲门癌患者术后２４小时食管ｐＨ各项监测指标均高于正常（Ｐ＜０．０１）,但只有６０％的患者有典型胃食管反流症状;（２）胸内吻合与腹内吻合、套入式吻合与围巾式吻合相比,监测结果无显著差别（Ｐ＞０．０５）;（３）术后上身抬高３０°仰卧的患者,监测指标均明显低于对照组（Ｐ＜０．０１）。由此得出结论：（１）贲门癌患者术后普遍存在胃食管反流;（２）上身抬高可明显减少胃食管反流;（３）目前常用的一些手术吻合方法不能减少胃食管反流;（４）尽管某些患者没有反流的典型症状,胃食管反流仍存在。     

用24小时食管pH监测法诊断食管原性胸痛

应用２４小时食管ＰＨ监测法检查３０例排除了食管形态学改变的胸痛患者，发现其中２６例ＰＨ值异常，存在异常胃食管反流。ＰＨ值昼夜异常者１６例，单纯白天异常者８例，单纯夜间异常者２例。胸痛与酸暴露相关者１８例。食管ＰＨ监测是诊断胃食管反流所致之食管原性胸痛的有效方法。该法对酸暴露、食管酸清除能力与胸痛关系的分析以及食管原性胸痛与心原性胸痛的鉴别具有重要作用。     

胃食管吻合术后残余食管胸胃运动功能研究

目的探讨食管、贲门癌切除后不同部位的食管胃吻合对残余食管和胸腔胃运动功能的影响。方法按手术中食管胃吻合部位不同,将39例食管、贲门癌患者分为两组,弓上吻合组:21例,为食管中段癌患者行食管胃主动脉弓上吻合;弓下吻合组:18例,为食管下段癌及贲门癌患者,行食管胃主动脉弓下吻合。对照组:为6例无胃食管反流症状的健康人。3组均行食管测压、上消化道X线钡餐造影检查,观察残余食管和胸腔胃运动功能。结果两吻合组部分患者均存在吻合口高压区,残余食管静息压均明显高于对照组(P<0.05),并与胸腔胃内静息压无明显差别(P>0.05);两吻合组残余食管和胸腔胃内静息压比较差别均无统计学意义(P>0.05)。弓上吻合组残余食管蠕动性收缩幅度及原发蠕动次数均明显低于或少于对照组,残余食管原发蠕动次数明显少于弓下吻合组(P<0.05)。术后3个月上消化道X线钡餐造影显示,两吻合组患者胸腔胃底、胃体部均无蠕动性收缩,蠕动收缩自胃窦部向幽门运动,速度缓慢,胃内钡剂排空缓慢;术后1年两吻合组胃窦部蠕动收缩均有明显恢复。结论食管、贲门癌患者术后食管胃吻合口无抗反流作用,食管胃吻合位置越高残余食管蠕动功能越差,但不影响残余食管和胸腔胃内静息压。食管、贲门癌术后胸腔胃运动功能减弱,随着时间的延长逐渐恢复,但很难达到正常水平。     

两种弓上食管胃吻合术后胃食管反流的比较

目的比较食管癌手术行"隧道式"式和器械式两种经主动脉弓上食管胃吻合方式术后胃食管反流的状况。方法对两组患者,"隧道式"吻合术组21例,器械吻合方式组35例,术后3个月行24 h食管pH监测;胃镜检查反流性食管炎的程度,并进行分级和评分。结果24小时pH监测显示,两组各项指标均高于正常值,但隧道组各项指标均低于器械式吻合组,差异有统计学意义:DeMeester评分和超过5 min的反流次数、pH低于4的总时间、以及pH<4的时间百分数(P<0.01)、24 h反流的次数和最长的反流时间(P<0.05);胃镜检查结果显示:器械组反流性食管炎的发生率为65.7%(23/35),明显高于隧道组为38.1%(8/21),两组反流性食管炎分级及反流性食管炎评分比较差异有统计学意义(P<0.01),器械组高于隧道组。结论两种吻合方式术后均有胃食管反流,弓上隧道式食管胃吻合术患者术后反流性食管炎的发生率和反流程度均小于器械吻合术式。     

切除食管癌两种消化道重建方式术后胃食管反流的对比观察

目的：探讨食管癌切除后胃经食管床和经胸作弓上吻合者术后发生胃食管反流的差别。方法：对２５例病人在术后１～３个月间进行了残留食管内的２４小时ｐＨ监测。结果：（１）两种消化道重建方式病人的ｐＨ总得分、２４小时的总反流次数、＞５分钟的反流次数、最长反流时间和ｐＨ＜４的总时间均超出正常范围。（２）将食管床组和胸内组相比较，２４小时总反流次数差异无显著性（Ｐ＞００５），而其余４项指标食管床组明显低于胸内组（Ｐ＜００５）。结论：（１）两种消化道重建方式术后均在存胃食管反流。（２）胃经食管床吻合术后的反流量和反流持续时间明显低于胃经胸弓上吻合术。（３）胃经食管床吻合病人可以获得较好的生活质量。     

食管癌围手术期胃食管反流pH监测分析及探讨

目的：了解食管癌与胃食管反流之间的关系。方法：对２３例食管癌病人进行了手术前食管２４小时ｐＨ监测，其中６例尚行了手术后胃食管２４小时ｐＨ监测。结果：食管癌病人手术前后均存在病理性食管反流，其反流液不单纯为酸性胃液，还含有十二指肠碱性反流成分。结论：应重视食管癌围手术期胃食管反流的检查与治疗，食管癌根治术中应设计相应的抗反流措施。     

食管胃吻合旋转包埋缝缩法抗胃食管反流的临床研究

目的 探讨食管胃吻合旋转包埋缝缩法和食管胃吻合包埋缝缩法在食管下端癌及贲门癌术后胃食管反流发生率的差异。方法 对分别采用食管胃吻合旋转包埋缝缩法和食管胃吻合包埋缝缩法（对照组）各25例术后1－3个月进行随访。结果 食管胃吻合旋转包埋缝缩法术后的胃食管反流临床症状明显低于对照组（P＜0.05）;钡餐结果食管胃吻合旋转包埋缝缩法发生胃食管反流的机率明显低于对照组（P＜0.05）;pH监测结果食管胃吻合旋转包埋缝缩法与对照组有显著性差异（P＜0.05）;结论 食管胃吻合旋转包埋缝缩法能有效抗胃食管反流,术后病人生活质量明显提高。     

胃食管吻合术后胃食管反流的研究

目的 研究食管癌和贲门癌术后不同位置的食管胃吻合口和时间因素对胃食管反流程度的影响。方法 对39例食管癌和贲门癌术后病人进行24h食管pH监测、电子胃镜检查，其中食管胃弓上吻合组（A组）21例，弓下吻合组（B组）18例。结果 （1）A组DeMeester评分和反流性食管炎评分均明显低于B组（P〈0．05）。（2）随着时间的推移A组和B组DeMeester评分无明显的改变（P〉0．05）。结论 不同位置的食管胃吻合口影响胃食管反流程度，食管胃吻合口位置越高胃食管反流和反流性食管炎程度越轻。时间因素对胃食管反流程度无明显的影响。     

不同平面胃食管吻合术后食管腔内24小时pH监测

目的为了解食管癌、贲门癌切除术后胃食管在颈部、弓上和弓下吻合术后发生胃食管反流的差异。方法对１０例正常人和３０例在３个不同平面作胃食管吻合的患者术后１～３月进行残留食管腔内连续２４小时ｐＨ监测。结果（１）食管癌、贲门癌患者术后无论吻合平面位于何处，术后近期内２４小时食管腔内ｐＨ各项监测指标均高于正常（Ｐ＜０．０１）；（２）２４小时总反流次数在３个不同吻合平面吻合术间无差异（Ｐ＞０．０５）；（３）其余监测指标颈部吻合＞弓上吻合＞弓下吻合（Ｐ＜０．０１）。结论食管癌、贲门癌患者术后普遍存在胃食管反流现象。吻合平面越高，反流越严重。降低吻合平面，缩小胸胃体积有利于减少术后反流，提高生活质量。     

食管功能检查的临床应用

目的 探讨食管腔内压力测定和２４小时食管ｐＨ监测在临床的应用价值。方法 用上述食管功能检查方法对：（１）胃食管反流性疾病采用内、外科不同治疗方法的比较：（２）鉴别食管源性胸痛;（３）评价抗酸药物的作用;以及（４）胆囊切除术后胃食管功能监测等。结果 通过食管功能检查完成了对上述四项内容的验证和评价,取得了良好的效果。结论 食管腔内压力测定和２４小时食管ｐＨ监测是诊断食管功能性疾病是最敏感和特异的检查     

Mechanisms responsible for recurrent gastroesophageal reflux in neurologically impaired children who underwent laparoscopic Nissen fundoplication

Background: In this study, we attempted to define the lower esophageal sphincter (LES) motor events associated with the occurrence of gastroesophageal reflux (GER) in neurologically impaired children in whom of GER disease recurred after laparoscopic Nissen fundoplication (LNF). Methods: Of 45 neurologically impaired children who had previously undergone LNF, six children in whom recurrence of GER disease was documented by 24-h esophageal pH monitoring were studied. Concurrent esophageal manometry and pH monitoring were conducted for 1 h both before and after the administration of apple juice (10 ml/kg). Results: A total of 89 reflux episodes were recorded in the course of the study. Of these, 51 episodes (57%) were associated with transient LES relaxation. In the remainder, reflux occurred across a contracted LES in 21 episodes (24%) and during absent basal LES tone in 15 episodes (17%). In four of six patients, transient LES relaxation was responsible for more than half of the reflux episodes. Conclusion: Transient LES relaxation is the predominant mechanism of reflux in neurologically impaired children with recurrent GER after LNF.     

Gastroesophageal reflux during pregnancy: 24-hour esophageal ph monitoring

Gastroesophageal reflux (GER) occurs in 30-50% of all pregnancies. The progressive rise in plasma progesterone has been suggested as a possible mediator of GER during pregnancy. Recent advances in technology have made it possible to detect GER through monitoring of esophageal pH for prolonged periods, including sleep. 24-hour pH monitoring is the proper method for diagnosing GER in pregnant women. If 24-hour esophageal pH monitoring is to be a useful diagnostic tool, it must reliably discriminate GER patients despite daily variations in distal esophageal acid exposure. To address this issue, we studied 62 women (30 healthy non-pregnant women without GER symptoms and 32 pregnant women with GER symptoms-heartburn, acid regurgitation) with 24-hour esophageal pH monitoring. Intrasubject reproducibility of three pH parameters to discriminate the presence of abnormal acid reflux was determined (DeMeester score, Kaye score, circadian one hour diagram for pH < 4). Each patient was interviewed, using a reliable questionnaire detailing individual habits, life style characteristics and symptoms, at four time points during the first, second, third trimesters of pregnancy and post-partum period. Symptoms of GER are common in pregnancy and although GER rarely endangers maternal or fetal health, it can significantly affect patient comfort and quality of life. We conclude: 1. GER is almost constantly present during pregnancy, increasing with gestational age. 2. The most important pH--parameter is DeMcester score. 3. Heartburn disappear after delivery. 4. 24-hour esophageal pH monitoring is the gold standard for measuring acid exposure and is a reproducible test for the diagnosis of GER in pregnancy.     

婴幼儿食管裂孔滑疝与单纯胃食管反流的食管动力和pH分析

目的：了解婴幼儿食管裂孔滑疝（ＳＨＨ组）和单纯胃食管反流（ＧＥＲ组）的食管动力和ｐＨ特点。方法：对１５例经钡餐造影（ＧＩ）和手术证实的ＳＨＨ和１３例单纯ＧＥＲ病儿进行了食管动力和２４小时食管ｐＨ监测。结果：反流参数ＳＨＨ组和ＧＥＲ组食管下段括约肌长度（ＬＥＳＬ）［（１３１±０３１）ｃｍ对（１９０±０４６）ｃｍ］、压力（ＬＥＳＰ）［（１２１５±５６３）ｍｍＨｇ对（２３８５±７５０）ｍｍＨｇ］、屏障压（ＢＰ）［（９３８±５６３）ｍｍＨｇ对（２２２０±７５０）ｍｍＨｇ］,ＳＨＨ组均明显低于ＧＥＲ组（Ｐ＜００１）,而胃内压（ＧＰ）ＳＨＨ组高于ＧＥＲ组［（２１８±０６８）ｍｍＨｇ对（１５０±０３０）ｍｍＨｇ］,Ｐ＜００１。两组均有病理性反流,ＳＨＨ组反流参数除ｐＨ＜４反流次数外均高于ＧＥＲ组（Ｐ＜００１）。结论：ＳＨＨ的食管抗反流功能比单纯ＧＥＲ病儿明显低下,反流更严重。临床应对ＧＥＲ病儿特别是可疑ＳＨＨ者应定期进行食管动力和２４小时食管ｐＨ监测。     

Protective antireflux operation with feeding gastrostomy. Experience with children.

Regurgitation and aspiration of feedings is a significant problem in children with impaired oral intake fed via gastrostomy. Using extended (18-24 hour) esophageal pH monitoring to assess gastroesophageal reflux (GER), we studied prospectively 32 children (aged 2 to 16 years) referred for feeding gastrostomy. Twenty-five patients had repeat esophageal pH monitoring after surgery. Prior to surgery, GER was documented in 23 (72%) of the 32 children. Twenty-two of the 23 children with GER before surgery had an antireflux operation performed in conjunction with the feeding gastrostomy. Gastroesophageal reflux was clinically significant in the single failed antireflux operation and in the child with GER before surgery who only had a gastrostomy performed. All nine patients without GER only had gastrostomy performed. Six of these developed GER by pH monitoring after surgery, with significant vomiting in four. Of our 11 patients remaining at risk for GER after surgery, seven (64%) had persistent vomiting with gastrostomy feedings. Thus, 91% (29 of 32) of the children were potentially at risk for GER if a gastrostomy only was performed. We believe these data support the need for a "protective" antireflux operation in children referred for feeding gastrostomy.     

管状胃－食管吻合术与全胃－食管吻合术对食管中段癌患者术后胃食管反流的对比研究

目的探讨管状胃－食管吻合术与全胃－食管吻合术对食管中段癌术后患者胃食管反流(GER)的影响。 方法回顾性分析2014年1月—2017年1月在新疆维吾尔自治区人民医院胸外科行食管癌切除术的56例食管中段癌患者的临床资料,其中观察组(管状胃－食管吻合术)患者27例,对照组(全胃－食管吻合术)患者29例,术后2周进行24 h胃－食管腔pH值监测,术后2周和1、3、6个月依据胃食管反流病调查问卷(GerdQ)评分表对患者的GER相关症状进行评分,比较两组患者术后GER发生情况。 结果所有患者获得随访,观察组和对照组术后2周时24 h酸反流次数、最长酸反流时间和pH值<4的总时间均显著少于对照组,差异有统计学意义(P<0.05);术后1、3、6个月时,观察组GerdQ评分均显著低于对照组,差异也有统计学意义(P<0.05)。 结论管状胃－食管吻合术可显著降低食管中段癌患者术后GER的发生及严重程度。     

Clinical study on abnormalities of lower esophageal sphincter (LES) function in infancy and childhood with special reference to gastroesophageal reflux

For the purpose of clarifying lower esophageal sphincter function, which is representative of antireflux competence, 51 normal newborn and early infants and 28 newborn and infants with gastroesophageal reflux were examined by standardized manometric studies. Barium studies and 24-hour pH monitoring in the distal esophagus were also performed, and the following results were obtained. 1) In normal infants, there was no correlation between LES pressure and age, but LES length increased with age. 2) LES Pressure of GER infants (22.2 +/- 6.4 cmH2O) was lower than normal infants (37.6 +/- 8.8 cmH2O). This indicated LES function was lower in GER infants. 3) In GER infants, LES pressure increased to within normal range with clinical improvement. The critical point of LES pressure was 27 cmH2O. 4) In radiological studies in GER infants there was no correlation between the grade of Barium regurgitation and LES pressure, or between HIS angle, Fornix Index and LES pressure. 5) On 24-hour pH monitoring, pH score of GER infants was very much higher than that of normal infants. LES incompetence din GER infants was also recognized in this investigation. Esophageal manometric study was very useful for diagnosis of LES dysfunction and assessment of therapeutic effect. For evaluation of anti-reflux cardiac function, multiple approaches were valuable, including not only manometric studies but also radiologic studies and 24-hour pH monitoring.     

Importance of preoperative and postoperative pH monitoring in patients with esophageal achalasia

Gastroesophageal reflux (GER) can develop in patients with esophageal achalasia either before treatment or following pneumatic dilatation or Heller myotomy. In this study we assessed the value of pre- and postoperative pH monitoring in identifying GER in patients with esophageal achalasia. Ambulatory pH monitoring was performed preoperatively in 40 patients with achalasia (18 untreated patients and 22 patients after pneumatic dilatation), 27 (68%) of whom complained of heartburn in addition to dysphagia (group A), and postoperatively in 18 of 51 patients who underwent a thoracoscopic (n=30) or laparoscopic (n=21) Heller myotomy (group B). The DeMeester reflux score was abnormal in 14 patients in group A, 13 of whom had been treated previously by pneumatic dilatation. Two types of pH tracings were seen: (1) GER in eight patients (7 of whom had undergone dilatation) and (2) pseudo-GER in six patients (all 6 of whom had undergone dilatation). Therefore 7 (32%) of 22 patients had abnormal GER after pneumatic dilatation. Postoperatively (group B) seven patients had abnormal GER (6 after thoracoscopic and 1 after laparoscopic myotomy). Six of the seven patients were asymptomatic. These findings show that (1) approximately one third of patients treated by pneumatic dilatation had GER; (2) symptoms were an unreliable index of the presence of abnormal GER, so pH monitoring must be performed in order to make this diagnosis; and (3) the preoperative detection of GER in patients with achalasia is important because it influences the choice of operation. Presented at the Thirty-Seventh Annual Meeting of The Society for Surgery of the Alimentary Tract, San Francisco, Calif., May 19–22, 1996.