食管胃前壁吻合加胃底重建预防反流性食管炎临床研究

目的探讨食管胃前壁吻合及胃底重建在胃底贲门癌切除术后预防反流性食管炎的价值。方法对310例胃底贲门癌患者常规经上腹正中切口行近端胃根治术后,170例行食管胃前壁吻合加胃底重建重新形成His角(A组),140例单纯行食管胃后壁吻合(B组)。术后观察临床症状和通过上消化道造影及胃镜检查来评定其抗反流效果。结果食管胃前壁吻合抗反流优良率达78%。食管胃后壁吻合抗反流优良率35%,经统计学处理二者抗反流差别有显著性意义(<0.01)。结论食管胃前壁吻合加胃底重建能有效预防反流性食管炎,是一种简便、较理想的消化道重建术式。

The Effect of Esophago-front Wall Gastric Anastomosis and Reconstrcution of Gastric Fundus on Preventing Reflux Esophagitis

Objective To explore the effect of esophago-front wall gastric anastomosis and reconstruction of gastric fundus on preventing reflux esophagitis(RE).Methods 310 patients with gastric fundus and cardiac cancer treated with radical proximal subtotal gastrectomy,170 patients underwent esophago-front wall gastricl anastomosis and reconstrcution of gastric fundus to rebuild His angle.(Group A);140 patients underwent esophago-post wall gastricl anastomosis(Group B).All of the patients were followed-up for 6 months and examined with barium meal and gastroscopy.Results The rates of fine were 78% in group A,35% in groupB.There was significant difference in RE prophylaxis between group A and B(P<0.01).Conclusion Esophago-front wall gastric anastomosis and reconstruction of gastric fundus reduces the incidence of reflux esophagitis.It is a simply and safe reconstructing operation with less complications.