食管癌贲门癌切除机械吻合术后胃食管反流的诊断和治疗

目的 探讨食管癌贲门癌切除食管胃机械吻合术后重建食管与胃食管反流之间的关系。方法 对50例食管癌术后患者进行了食管胃的压力测定，其中25例尚行了24h食管pH监测和内镜及病理检查，以及35例贲门癌术后患者进行食管胃压力测定，其中20例行24h食管pH监测，15例行内镜和病理学检查。结果 测压结果显示：吻合口与吻合口下方的静息压相似，两者比较差异无显著性（P〉0．05），而吻合口上方静息压增高，食管癌组平均为4．28mmHg，贲门癌组平均为3．46mmHg，经比较食管癌组和贲门癌组吻合口上方和吻合口下方差异有显著性（P〈0．05）。值得注意的是食管癌组压力值（4．28mmHg）和贲门癌组压力值（3．46mmHg）远低于正常括约肌的静息压（10～45mmHg），因此其抗反流作用的程度是有限的。食管癌组和贲门癌组食管24hpH监测表明食管的酸暴露时间延长，食管酸暴露时间平均百分比分别为11．76％和13．88％，为正常人的9倍和11倍，反流次数增加，最长反流时间达32min和38min，说明手术后的胃食管反流是客观存在的。内镜和病理检查，80．0％的食管癌和86．7％的贲门癌有异常现象及食管炎征象，进一步证实术后患者有不同程度的反流性食管炎。结论 食管癌贲门癌切除食管胃吻合术后存在胃食管反流；反流的发生不因机械吻合或手工吻合而异；反流的发生与术后时间的长短无关；24h食管pH监测是最敏感的观察方法；半卧位睡眠是预防反流的有效方法；反流的治疗主要应用促动力药和黏膜保护剂。

Diagnosis and treatment of gastroesophageal reflux after excision for esophageal carcinoma and cardiac cancer undergoing stapled anastomosis

Objective] To investigate the relation between excision for esophageal carcinoma and cardiac cancer undergoing stapled anastomosis and gastroesophageal reflux(GER).Methods] Eighty-five patients were measured by using computer manometer.Fourty-five cases were studied by 24 h pH esophageal monitoring.Fourty cases were examined by endoscopy and pathological examination.Results] Resting pressure above the esophago-gastric anastomisis was higher than that under the esophago-gastric anastomosis.Twenty-four hour pH monitoring demonstrated that GER.Abnomalities were found in 80.0% and 86.7% of patients through endoscopy and pathological examination.Conclusions] GER exists in the patients after excision for esophageal carcinoma and cardiac cancer.The occurrence of GER with stapled anastomosis are similar to manual anastomosis.The occurrence of GER is not affected by the length of postoperative period.Twenty-four hour pH monitoring is the most reliable method for detecting GER.Sleep in semireclining position is an effective method of preventing GER in postoperative patients.It is important that treatments of GER are mainly prokinetics and mucosal coating agents.