贲门癌切除术后预防反流性食管炎术式探讨

[目的]探讨贲门癌胃大部根治切除术后理想的预防反流性食管炎消化道重建术式。[方法]对83例贲门癌患者行根治性近端胃大部切除术后,分别行食管残胃吻合术(A组),食管残胃吻合并幽门成形术(B组),食管残胃吻合并残胃空肠吻合引流术(C组)三种消化道重建方式,术后观察临床症状和行上消化道钡餐、胃镜检查。[结果]A组反流性食管炎22例(64.7%),B组8例(34.8%),C组1例(3.8%)。通过术后随访对临床症状、上消化道钡餐、胃镜检查进行对比,贲门癌行近端胃大部根治切除、残胃食管吻合并残胃空肠吻合引流术在预防反流性食管炎上优于幽门成形术,差异有显著性(P<0.01),且并发症少,体重恢复好。[结论]贲门癌行近端胃大部根治切除、残胃食管吻合并残胃空肠吻合引流术具有预防反流性食管炎和十二指肠液反流的作用,同时能促进残胃排空,是一种安全简便、较理想的消化道重建术式。

The Surgical Modality of Reflux Esophagitis Prophylaxis after Proximal Subtotal Gastrectomy for Cardiac Carcinoma

To explore the surgical modality of reflu x esophagitis(RE)prophylaxis after proximal subtotal gastrectomy(PSG)of cardiac ca rcinoma.Of83patients with cardiac carcinoma treated with radical proxim al subtotal gastrectomy,34patients underwent PSG(Group A),23patients underwent P SG combined with disconnection of pyloric sphincter(Group B)and26patients underw ent PSG combined with gastrojejunostomy(Group C).All of the patients were follow ed-up for3months and examined with barium meal and gastroscopy.The rat es of RE were64.7%(22cases)in Group A,34.8%(8cases)in Group B and3.8%(1case)in G roup C.Based on gastroscopy and barium meal examination in the three groups,ther e was significant difference in RE prophylaxis after PSG for cardiac cancer of t he stomach between group C and B(P<0.01).Less postoperative complications and b etter body weight were showed in Group C.[Con-clusions]PSG combined with not on ly improves gastric emptying,but also prevents RE and duodenogastric re-flux.It is a simply and safe reconstructing operation with less complications.