食管癌和贲门癌术后24h食管pH监测分析

目的观察食管癌和贲门癌切除术后患者胃食管反流情况,探讨不同手术吻合方式对胃食管反流的影响。方法 80例食管癌和贲门癌患者随机分为两组:A组40例,采取平卧位睡眠;B组40例,采取上身抬高30°～40°仰卧睡眠。监测患者24 h食管pH值。同时比较A组采用不同吻合术式患者24 h pH监测结果。结果 A组患者反流次数、时间>5 min反流次数、单次最长反流时间、pH<4的总时间、pH<4的百分数、DeMeester评分均明显高于B组,差异有统计学意义(P<0.05)。A组套入式吻合组和端侧吻合组患者反流次数、时间>5 min反流次数、单次最长反流时间、pH<4的总时间、pH<4的百分数、DeMeester评分比较,差异均无统计学意义(P>0.05)。结论食管癌和贲门癌患者术后均存在胃食管反流,上身抬高可明显减少胃食管反流,套入式吻合与端侧吻合方法均不能减少胃食管反流,术式的改进仍需进一步研究。

Analysis and Monitoring of 24 Hours Postoperative Esophageal pH in Patients with Esophagus Cancer and Cardiac Cancer

Objective To observe the gastro-esophageal reflux(GER) of patients with esophageal carcinoma and cardiac carcinoma after resection and to investigate the influence of different anastomosis on GER.Methods 80 patients with esophageal carcinoma and cardiac carcinoma were randomly divided into group A and group B,with patients in group A sleeping in horizontal position and patients in group B sleeping in supine position with upper body elevating by 30 degree to 40 degree.Esophageal pH was monitored for 24 hours.The monitoring results of 24 h pH among patients with different anastomosis in group A were compared.Results Times of GER,times of GER over five minutes,longest single GER,total time of pH<4,percentage of pH<4 and DeMeester grading in group A were all significantly higher than those of the group B(P<0.05).The above mentioned parameters showed no statistically significant differences between patients with encasing-in style and patients with end-to-side style in group A(P>0.05).Conclusion All patients with esophageal carcinoma or cardiac carcinoma have postoperative GER.Elevating upper body can significantly alleviate GER.Encasing-in anastomosis and end-to-side anastomosis cannot alleviate GER,and the improvement of surgical treatment remains to be researched.