贲门癌近端胃切除后残胃间置对胃酸和食管胃压力的影响

目的了解贲门癌行近端胃切除后残胃间置对胃功能的影响,以探讨减少贲门癌术后并发症、改善患者生活质量的更佳术式.方法对21例贲门癌患者行近端胃次全切除、残胃间置消化道重建术.术后行24h食管胃pH监测及压力测定,并与传统术式及术前监测结果进行比较.所有病例常规行纤维内镜及上消化道造影检查.结果(1)残胃间置组术后酸反流6项指标明显优于传统组(P＜0.01),24h食管pH＜4的总百分时间、立位pH＜4的百分时间、反流次数、反流持续超过5min的次数与术前相似(P＞0.05),但上述指标传统组术后较术前明显增加(P＜0.01).(2)两组术后食管残胃吻合口高压带长度及静息压力较术前食管下括约肌长度和静息压力明显下降(P＜0.01),但残胃间置组食管残胃吻合口静息压力和残胃静息压力较传统组明显下降(P＜0.05).(3)残胃间置组仅2例发生中度反流性食管炎,而传统组有12例发生中重度反流性食管炎(P＜0.01).结论贲门癌切除后行残胃间置重建消化道,能进一步降低酸反流及残胃静息压力,促进残胃排空,改善术后症状,提高生活质量,是一种较为理想的手术方法.

The functional changes of residual stomach after subtotal gastrectomy in patients with carcinoma of gastric cardia

Objective To observe the functional changes of residual stomach after subtotal gastrectomy in patients with carcinoma of gastric cardia. Methods The proximal subtotal gastrectomy was performed in 21 patients with carcinoma of gastric cardia and the digestive tract was reconstructed by gastric remnant interleafing. After the operation, the pH and the esophageal-gastric pressure were monitored, and the results were compared with those in traditional operation group. Results (1) The 24 h monitoring of esophageal-gastric pH and six indicators of acid reflux in gastric remnant interleafing group were superior over those in the conventional operation group (P<0.01). (2) The length of high-pressure region and static pressure in anastomosis of esophageal gastric remnant in gastric remnant interleafing group was lower than that in pre-operation group (P<0.01), and the conventional group (P<0.05). (3) In gastric remnant interleafing group there were only 2 cases had moderate reflux esophagitis while 12 cases of severe reflux esophagitis in conventional surgery group. Conclusion Gastric remnant interleafing after the resection of cardiac carcinoma and the reconstruction of digestive tract are considered a favorable operation.