食管中段癌切除术后食管胃吻合附加改良Nissen折叠术的抗反流作用探讨

目的 探讨食管中段癌切除术后食管胃吻合附加改良Nissen折叠术的抗反流作用.方法 将82例食管中段癌患者按随机数字表法分为两组,分别采用食管癌切除常规吻合器吻合（对照组,41例）和常规器械吻合基础上附加改良Nissen折叠术（观察组,41例）.术后3个月,对两组患者进行EORTC QLQ-C30问卷调查,并进行食管测压及内镜检查.结果 两组患者术后并发症发生率比较差异无统计学意义（P＞0.05）,无围手术期死亡.观察组烧心和胃液反流评分分别为（13.2±6.1）,（16.9±3.9）分]明显低于对照组分别为（25.6±7.2）,（26.6±4.2）分],差异有统计学意义（P＜0.05）,而吞咽困难评分两组比较差异无统计学意义（P＞0.05）.观察组吻合部位静息压（3.5±2.3）mmHg,1 mmHg =0.133 kPa]高于胃内压（2.7±2.1）mmHg],差异有统计学意义（P＜0.05）.观察组DeMeester评分为（54±32）分,低于对照组的（141±84）分,差异有统计学意义（P＜0.05）.观察组的反流性食管炎发生率为48.8％（20/41）,要明显低于对照组的75.6％（31/41）,差异有统计学意义（P＜0.05）.结论 食管胃吻合附加改良Nissen折叠术可增加吻合部位的压力,具有降低胃食管反流、减轻反流性食管炎和胃食管反流症状的作用.

Investigation of the antireflux effect of esophagogastrostomy combined with modified Nissen fundoplication after esophageal middle cancer resection

Objective To investigate the antireflux effect of esophagogastrostomy combined with modified Nissen fundoplication after esophageal middle cancer resection.Methods Eighty-two patients with esophageal middle cancer were divided into 2 groups by random digits table method,41 cases underwent esophagogastrostomy with a stapler only （control group）,41 cases underwent esophagogastrostomy with stapler combined with modified Nissen undoplication （observation group）.Three months after surgery,the patients of the 2 groups completed the research of EORTC QLQ-C30 questionnaire,and examined with esophageal manometry and gastroscopy.Results There was no statistical difference in incidence of postoperative complication between the 2 groups （P 〉 0.05）,death was not found during peroperative period.The scores of heart burn and regurgitation in observation group （13.2 ± 6.1） and （16.9 ± 3.9） scores] were significantly lower that those in control group （25.6 ± 7.2） and （26.6 ± 4.2） scores],there were statistical differences （P 〈 0.05）,but there was no statistical difference in score of dysphagia between the 2 groups （P 〉 0.05）.The resting pressure of anastomotic site in observation group （3.5 ± 2.3） mmHg,1 mmHg =0.133 kPa] was significantly higher than that in the stomach （2.7 ± 2.1） mmHg],there was statistical difference （P〈 0.05）.The DeMeester score was （54 ± 32） scores,control group was （141 t 84） scores,there was statistical difference （P 〈 0.05）.The incidence of reflux esophagitis in observation group was 48.8%（20/41）,in control group was 75.6%（31/41）,there was statistical difference （P 〈 0.05）.Conclusions Esophagogastrostomy combined with modified Nissen fundoplication after esophageal middle cancer resection significantly increases the pressure at the anastomotic site,thus reduces the extent of gastroesophageal reflux,which leads to the reduction of the extent of reflux esophagitis and the improvement of the quality of life.