胸胃固定术对食管癌患者手术后肺功能的影响

目的：探讨胸胃固定术对食管癌患者手术后肺功能和生活质量的影响。方法：选择胸段食管癌右胸三切口手术病例40例，按入院手术治疗顺序随机分成研究组20例，在常规完成胃食管颈部吻合后不缩胃，行纵隔胸膜残迹缝合胃固定术；对照组20例常规将胃缩成胃管塞入食管床，不做胸胃固定。监测2组患者手术后7d、1个月、6个月和12个月时MVV占顸计值百分率、VC占预计值百分率、FEV，占预计值百分率、PaO2、心电图、围手术期并发症以及胸胃扩张程度。结果：对照组胸胃均有不同程度的扩张或移位，而研究组无胸胃扩张和移位。2组MVV占预计值百分率、VC占预计值百分率、PaO2在术后各时点差异均有统计学意义，P均〈0．05。FEV1占预计值百分率在术后1个月后差异有统计学意义，P〈0．05。对照组围手术期并发症和胸胃综合征的发生率均高于研究组，P〈0．01。结论：胸胃固定术有效控制了胸胃的扩张和移位，对减少患者手术后肺功能的损失，降低手术并发症，提高术后生活质量有很大帮助。

Effect of thoracic stomach fixation on pulmonary function after esophagectomy for esophageal carcinoma

OBJECTIVE:To study the effect of the thoracic stomach fixation on pulmonary function and the quality of life after the esophagectomy for esophageal carcinoma.METHODS:Forty patients with esophageal carcinoma in chest underwent esophagectomy through right open-thoracotomy and 3 cuts.They were divided into the study group(n=20) and control group(n=20) at random.In the study group,the patient's pleura stump and stomach were stitched and fixed together after esohagogastral anastomosis at neck through esophageal bed,and the stomach was not contracted into tube.In the control group,their stomach were contracted into tube and inserted into esphageal bed,not fixed with the esophagus.The patients were monitored on the seventh day,first month,sixth month,twelfth month after the operation for the rates of MMV,VC and FEV1,PaO2,EKG,complication,the degree of thoracic stomach,enlargenent and the rate of thoracic stomach syndrome.RESULTS:The patients' thoracic stomach was enlarged and moved in different degrees in the control group,but non in the study group.There was a significant difference in the rates of MVV,VC,PaO2 at any time between the two groups,P<0.05.There was a significant difference in the rate of FEV1 after the first postoperative month between the two groups,P<0.05.The rate of the complication and the thoracic stomach syndrome after the operation were higher in the control group than in the study group.There was a significant defference between the two groups,P<0.01.CONCLUSION:The thoracic stomach fixation can reduce the thoracic stomach enlargement and movement,reduce the pulmonary function loss and operation complications,and improve the quality of life of the patients after the operation.