胃食管吻合术联合Nissen胃底折叠术对食管中段癌患者术后胃食管反流的影响

目的探讨胃食管吻合术联合Nissen胃底折叠术对食管中段癌术后患者胃食管反流的影响。 方法选取2015年9月至2017年3月，新疆维吾尔自治区人民医院住院并行食管癌切除术31例食管中段癌患者的临床资料。根据手术方式分为2组，即接受胃食管吻合术联合Nissen胃底折叠术15例（观察组），接受胃食管吻合术16例（对照组），术后2周待患者恢复正常的胃肠道功能后采用pH动态监测仪对其进行24 h pH监测，术后1、3、6、12个月依据胃食管反流病调查问卷（GerdQ）对患者的胃食管反流相关症状进行评分，比较2组患者术后胃食管反流发生情况。 结果2组患者均未出现死亡病例，且术后均未发生有吻合口瘘及胸胃排空障碍等并发症；观察组患者术后2周24 h酸反流次数显著少于对照组、最长酸反流时间和pH值<4的总时间短于对照组，DeMeester评分显著低于对照组，组间比较均有统计学意义（P<0.05）；观察组术后3、6、12个月胃食管反流病调查问卷（GerdQ）评分显著低于对照组，组间比较均有统计学意义（P<0.05）。 结论胃食管吻合术联合Nissen胃底折叠术对食管癌切术后的胃食管反流病情起到更为理想的控制效果，为食管中段癌患者术中吻合术式的选择提供一定参考价值。

Effects of postoperative gastroesophageal reflux for esophageal cancer patients who Gastroesophageal anastomosis combined with fundoplication

ObjectiveTo investigate the effect of gastroesophageal anastomosis combined with Nissen fundoplication on postoperative gastroesophageal reflux in esophageal cancer operation patients. MethodsA retrospective analysis from September 2015 to March 2017 in the people's Hospital of Xinjiang Uygur Autonomous Region who parallel resection in 31 cases of esophageal cancer patients, according to the operation mode divided into two groups, the observation group received esophagogastric anastomosis combined with Nissen fundoplication (15 cases), the control group received non fundoplication whole stomach esophagus anastomosis (16 cases), after the surgery until the patient to return to normal gastrointestinal function uses dynamic monitor its pH 24 h esophageal pH monitoring chamber, the other respectively after 1, 3, 6, 12 month using GerdQ and compared with two groups of patients postoperative gastroesophageal reflux. ResultsThere were no deaths occurred, and no occurrence of postoperative anastomotic fistula and thoracic gastric emptying dysfunction, etc; 24 hours reflux episodes long Nissen fundoplication group and significalldy less than the number Of non fundoplication whole stomach esophagus anastomosis, the longest duration of reflux and pH value<4.00 The cumulative time was significantly shorter in non fundoplication whole stomach esophagus anastomosis, DeMeester scores were significantly lower than the non fundoplication whole stomach esophagus anastomosis group, between groups were statistically significant (P<0.05), and after 1、3、6、12 month later the gastric reflux disease questionnaire (GerdQ) score was significantly lower than the non fundoplication whole stomach esophagus anastomosis group (P<0.05). Conclusionesophagogastric anastomosis combined with Nissen fundoplication compared with conventional non fundoplication whole stomach esophagus anastomosis resection Of esophageal cancer has a more ideal GER disease controleffect, and can provide a reference for the choice of nastomosis ways for patientswith esophageal cancer surgery.