管状胃与全胃代食管术治疗食管癌的疗效比较

目的 比较管状胃代食管术与全胃代食管术治疗食管癌的临床疗效。方法 回顾性分析2007年1月至2012年1月在我院接受食管癌手术患者的病例资料；比较管状胃组（n=53）和全胃代食管组(n=48)患者在术中吻合口位置、术中出血量、手术时间、术后胃肠减压时间、胃肠减压量、胸腔闭式引流管拔除时间、胸腔引流液量、术后并发症发生情况及术后1个月的肺功能等临床指标上的差异。结果 管状胃组患者术后反流性食管炎的发生率为5.7％（3／53），低于全胃组的25.0％（12／48），差异具有统计学意义（P=0.01）；管状胃组无术后胸胃综合征，全胃组的发生率为8.3％（4／48）；管状胃组术后1个月的肺活量占预计值的百分比、最大通气量占预计值的百分比及第一秒用力呼气容积占预计值的百分比均显著高于全胃组，差异均有统计学意义（P＜0.01）。结论 管状胃代食管术较全胃代食管术可降低术后反流、胸胃综合征的发生率，且对患者术后呼吸功能影响较小。

Comparison of the clinical effect in patients with resectable esophageal cancer after esophagectomy followed by gastric tube or whole stomach reconstruction

Objective To evaluate the clinical therapeutic effect in patients with resectable esophageal cancer after esophage- ctomy followed by gastric tube or whole stomach reconstruction. Methods Clinical data of patients underwent esophagectomy for e- sophageal cancer in our hospital from 2007 to 2012 were retrospectively analyzed. Patients were divided into two groups, Group A（ n = 53 ） patients underwent gastric tube esophagectomy ; Group B （n = 48） patients underwent whole stomach reconstruction esophagectomy. The clinical indexes such as the level of anastomosis, the intraoperative bleeding, operation time, postoperative thoracic drainage and gastrointestinal decompression, drainage tube removal time, postoperative complications and respiratory function （ ratio of predicted val- ues of MVV%, FEV1.0%, VC% ） in patients of two groups were compared. Results Patients in Group A had lower rate of reflux esophagitis than patients in Group B. The difference was statistically significant（5.7% vs. 25.0% ,P = 0. 01 ）. Patients in Group A had lower rate of thoracic stomach syndrome than patients in Group B（0 vs. 8.3% ）. Patients in Group A had higher values of VC% , MVV% and FEV1.0% than patients in Group B. The difference was statistically significant （ P 〈 0. 01 ）. Conclusion The patients received esophagectomy followed by gastric tube has lower rate of reflux esophagitis and thoracic stomach syndrome than patients re- ceived esophagectomy followed by whole stomach reconstruction. Esophagectomy followed by gastric tube has less influence of postoper- ative respiratory function on patients.