食管癌贲门癌术后酸反流与十二指肠胃食管反流

目的 探讨食管癌和贲门癌术后酸反流和十二指肠胃食管反流(DGER)的相互关系、反流特征以及对食管黏膜的损伤作用.方法 对32例食管癌和贲门癌术后病人进行烧心、反酸症状调查,应用电子胃镜检查、24 h食管pH和胆红素同步监测.结果 (1)胃食管反流症状的发生率65.6%,反流性食管炎的发生率为75.0%,其中2例发生Barrett食管,发生率为6.25%.(2)24 h食管pH和胆红素监测结果显示,28.1%的病人仅存在酸反流,15.6%仪存在DGER,53.1%同时有酸反流和DGER.DeMeeste评分与abs>0.14的时间百分比无明显的相关性(P=0.3109).平卧位pH<4.00的时间百分比和abs>0.14的时问百分比明显高于直立位(P<0.05).(3)通过比较在不同pH区间内胆红素的吸收率,显示在pH 3～6的区间内,胆红素abs>0.14的时间百分比明显高于其他区间(P<0.05).(4)DeMeester评分和胆红素abs>0.14的时间百分比与反流症状评分无明显的相关(P>0.05),与反流性食管炎评分呈正相关(P<0.05).结论 食管癌和贲门癌术后存在广泛的酸反流和DGER,反流形式以混合性反流为主(同时出现酸反流和DGER),混合性反流对食管黏膜的损伤作用更严重.酸反流和DGER均受体位影响.24 h食管pH和胆红素同步监测有助于揭示反流特征及反流物对食管黏膜的损伤作用.     

管状胃宽度与食管癌术后抗胃食管反流的临床研究

目的总结采用管状胃的食管癌手术患者的术后反流情况,探讨管状胃宽度对食管癌切除术后胃食管反流的影响。 方法前瞻性地按照入院顺序,将60例食管癌术中采用管状胃代食管的患者按管状胃裁制宽度是否大于3 cm,随机分为A组30例(管状胃宽度≥3 cm)和B组30例(管状胃宽度<3 cm),分别在术后11～14 d胃肠功能恢复后使用pH监测仪进行24 h食管pH值监测。 结果A组反流次数、反流超过5 min的次数、pH值<4.00的总时间和最长反流时间均多于B组(t＝2.735,P＝0.012;t＝4.502,P＝0.001;t＝3.435,P＝0.023;t＝4.286,P＝0.002)。 结论管状胃宽度影响反流的发生,细的管状胃可减轻食管癌术后反流的发生。     

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。     

食管胃吻合口能否抗胃食管反流

目的 探讨食管胃吻合手术后吻合口能否起抗反流作用。方法 采用多指标检测方法,对１９２例贲门癌切除术后患者进行定量观察,行电子胃镜、食管压力测定、２４小时信姹ＰＨ监测、放射性核素检查和电镜检查。结果 内镜检查９０．２％有异常表现,其发生与术后期间长短无关。食管测压显示食管体部静息压明显高于正常人,胃内压则下降。２４小时食管ＰＨ监测平卧位睡眠患者均显示有反流,半卧位睡眠则否。放射性核素检查明显２／３的     

食管纵隔胃颈部吻合术后食管胃的压力监测及评价

目的检测食管癌切除食管、纵隔胃颈部吻合术后病人残余食管及胃的功能。方法采用国产SG-III型消化道压力检测仪对21例食管癌切除食管纵隔胃颈部吻合术后病人进行消化道压力检测,并与25名正常人测定值对照。结果术后病人咽部的静息压力为(1·20±2·03)mmHg(1mmHg=0·133kPa),收缩压为(72·37±16·95)mmHg;食管上括约肌的静息压力为(28·20±15·60)mmHg,关闭压为(107·10±28·43)mmHg;吻合口上方食管的静息压力为(15·98±11·10)mmHg,收缩压为(48·45±18·37)mmHg;胃的静息压力(3·53±3·30)mmHg,食管原发性蠕动的发生率为(57·14±34·50)%。其中吻合口上方食管的静息压力值明显高于正常成人(5·63±8·78)mmHg,差异有统计学意义(P<0·01)。结论食管癌切除食管胃颈部吻合术后,在吻合口上方的食管产生了新的压力区。该压力的形成与吻合时胃上提包套残余食管及颈部肌群等软组织共同对食管所造成的压力有关,具有一定的抗反流作用,食管胃颈部吻合的术式具有更好的减轻术后胃食管反流的作用,能改善病人术后生活质量。     

胃食管反流病如何选择抗反流术式

胃食管反流病(gastroesophageal reflux disease,GERD)引起的严重食管和食管外并发症越来越多,国内发病率呈上升趋势,自1936年Nissen开始第1例抗反流手术(antireflux surgery,ARS)以来,经过80年来上百种术式的演变,已基本固定为全包绕胃底折叠术和半包绕胃底折叠术两大类。关于ARS术式的争议从未停止,国内研究相对较少,且尚无     

胃食管反流病

引言在西方国家,胃食管反流病(gastroesophageal reflux disease,GERD)不仅发病率高,而且因该病的食管外临床表现(如哮喘、喉痉挛、顽固性咳嗽咳痰,以致鼻窦炎、咽炎等耳鼻喉科症状)有较广泛的认识和报道[1],且相比之下,该病在亚洲地区及我国的发病率和人们对本病的认识都显得较低。本文报道1例被诊断为哮喘并经正规治疗1年以上、基本无效、最终接受腹腔镜下胃底折叠术的患者,治疗后其严重的致命性呼吸道表现立即完全消失,并停止所有治疗GERD和哮喘的药物,患者康复。此病例因最终诊断为简单的GERD而不是哮喘,预示着在哮喘患者群中应该…     

食管裂孔疝合并胃食管反流病的外科治疗

胃食管反流病（gastroesophageal reflux disease, GERD）的外科治疗近年来日益受到重视,但是由于目前国内尚无胃食管反流病外科治疗的指南或专家共识意见,因此胃食管反流病的外科治疗仍然主要基于临床经验或参考国外指南。食管裂孔疝（hiatal hernia, HH）合并胃食管反流病临床多见,外科手术效果确切,但在临床实践中仍然存在一些问题,现综述如下。     

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。     

管状胃成形对预防食管癌切除术后胃食管反流的作用

目的探讨管状胃成形对减轻食管癌切除术后胃食管反流症的作用。方法选取2006年7月至2007年6月收治的120例食管癌患者,按手术术式不同分为两组,管状胃手术组:男42例,女18例;中位年龄58岁;传统手术组:男44例,女16例;中位年龄61岁。术后3个月行食管24 h pH监测,将5 min的反流次数、反流百分率、最长反流时间指标与正常人进行比较。结果传统手术组术后有明显反流症状26例(43.33%),管状胃手术组12例(20.00%)。传统手术组5 min的反流次数、反流百分率和最长反流时间均大于正常人(t=2.826,P0.05;t=2.212,P0.05;t=2.951,P0.05);管状胃手术组患者仅最长反流时间大于正常人(t=2.303,P0.05);5min的反流次数、反流百分率和最长反流时间均短于传统手术组,差异有统计学意义(t=2.081,P0.05;t=2.050,P0.05;t=2.112,P0.05)。结论管状胃成形能有效降低食管癌术后胃食管反流的发生率。     

Endoscopic sclerosis of the cardia affects gastroesophageal reflux

Summary Gastroesophageal reflux disease remains a disorder of unknown etiology associated with abnormal function of the lower esophageal sphincter (LES) and other physiological co-factors of the pathologic reflux. Effective operations for reflux are designed to reinforce the anti-reflux barrier and alter the tendency towards abnormal reflux. We have postulated that the most important component of these procedures is the prevention of distraction of the lowermost components of the LES at the onset of a potential reflux episode. Distraction of the LES causes shortening of the effective sphincter mechanism and can initiate experimental reflux events. In this study we used endoscopic sclerosis of the submucosal space at the cardia as a means of reducing distraction of the cardia in the hope that this would reduce abnormal reflux events. Canine gastroesophageal reflux was induced by intravenous atropine and monitored by continuous esophageal pH monitoring. Sclerosis of the cardia prevented gastroesophageal reflux, without measurable effect on the LES pressure or length. Endoscopic sclerosis of the cardia may be a useful technique in the control of human gastroesophageal reflux.Presented at the International Congress on Surgical Endoscopy, Ultrasound, and Interventional Techniques, Berlin 1988     

Role of the lower esophageal sphincter and hiatal hernia in the pathogenesis of gastroesophageal reflux disease

The relative importance of the lower esophageal sphincter (LES) and hiatal hernia in the pathogenesis of gastroesophageal reflux disease is controversial. To identify the role of hiatal hernia and LES in reflux disease, 375 consecutive patients with foregut symptoms and no previous foregut surgery were evaluated. All patients underwent upper endoscopy, stationary manometry, and 24-hour esophageal pH monitoring. Hiatal hernia was diagnosed endoscopically, when the distance between the crural impression and the gastroesophageal junction was ≥2 cm. The LES was considered structurally defective when the resting pressure was ≤6 mm Hg, the overall length was less than 2 cm, and/or the abdominal length was less than 1 cm. Factors predicting abnormal esophageal acid exposure (composite score >14.7) were analyzed using multivariate analysis. The presence of a hiatal hernia and a defective LES were identified as independent predictors of abnormal esophageal acid exposure. LES pressure and abdominal length were reduced in patients with hiatal hernia by 4 mm Hg and 0.4 cm, irrespective of the presence of gastroesophageal reflux disease. It is concluded that both a structurally defective LES and hiatal hernia are important factors in the pathogenesis of reflux disease. It is hypothesized that in the presence of a structurally normal LES, the altered geometry of the cardia imposed by a hiatal hernia facilitates the ability of gastric wall tension to pull open the sphincter. Presented at the Thirty-Ninth Annual Meeting of The Society for Surgery of the Alimentary Tract, New Orleans, La., May 17–20, 1998 (poster presentation).