管状胃与全胃代食管术对食管癌的疗效比较

目的:比较管状胃与全胃代食管术治疗食管癌的临床疗效.方法:选取食管癌病人46例,术后生存期均超过1年,根据消化系统重建方式分为管状胃组26例与全胃组20例.管状胃组给予管状胃食管吻合术治疗,全胃组给予全胃食管吻合术治疗.比较2组手术情况、手术前后肺功能指标及术后生活质量.结果:2组病人手术时间、术中出血量、胸腔引流量和住院时间差异均无统计学意义(P>0.05);管状胃组肺部并发症和反流性食管炎发生率均低于全胃组(P<0.05);2组病人术后最大通气量占预计值百分比、1s用力呼气容积占预计值百分比和肺活量占预计值百分比均较术前明显下降,全胃组下降更显著(P<0.01);管状胃组病人术后6个月、12个月生活质量评分均明显高于术后3周,且均明显高于术后同期全胃组评分(P<0.01).结论:管状胃代食管术相对于全胃代食管术治疗食管癌可有效降低反流性食管炎和肺部并发症发生率,同时对病人术后肺功能影响小,术后短期生存质量更高.

Efficacy comparison of the tubular stomach with full and full gastroesopha-geal anastomosis surgery in the treatment of esophageal carcinoma

Objective:To compare the clinical efficacy of tubular in the treatment of esophageal carcinoma. Methods:Forty-six patients with esophageal cancer ( survival time more than 1 year ) were divided into the tubular stomach group ( 26 cases ) and full stomach group(20 cases) according to the digestive tract reconstruction way. The tubular stomach group and full stomach group were treated with tubular gastroesophageal anastomosis surgery and full gastroesophageal anastomosis surgery, respectively. The operation condition,lung function and quality of life before and after operation between two groups were compared. Results:The differences of the operative time,intraoperative blood loss,chest drainage and length of hospital stay between two groups were not statistically significant (P>0. 05). The incidence rates of pulmonary complications and reflux esophagitis in tubular stomach group were lower than those in full stomach group(P<0. 05). Compared with before operation,the MMV%,FEV1% and VC% in two groups significantly decreased, and the decreasing degree of which in full stomach group was more obvious after operation(P<0. 01). The scores of quality of life of 6 and 12 months in tubular stomach group were significantly higher than that of 3 weeks after operation,and significantly higher than that of same postoperative period in full stomach group(P<0. 01). Conclusions:Compared with full gastroesophageal anastomosis surgery, the tubular gastroesophaged anastomosis surgery can effectively reduce the reflux esophagitis and incidence rate of pulmonary complications,has little effect on postoperative pulmonary function and high short-term quality of life.