切除食管癌两种消化道重建方式术后胃食管反流的对比观察

目的：探讨食管癌切除后胃经食管床和经胸作弓上吻合者术后发生胃食管反流的差别。方法：对２５例病人在术后１～３个月间进行了残留食管内的２４小时ｐＨ监测。结果：（１）两种消化道重建方式病人的ｐＨ总得分、２４小时的总反流次数、＞５分钟的反流次数、最长反流时间和ｐＨ＜４的总时间均超出正常范围。（２）将食管床组和胸内组相比较，２４小时总反流次数差异无显著性（Ｐ＞００５），而其余４项指标食管床组明显低于胸内组（Ｐ＜００５）。结论：（１）两种消化道重建方式术后均在存胃食管反流。（２）胃经食管床吻合术后的反流量和反流持续时间明显低于胃经胸弓上吻合术。（３）胃经食管床吻合病人可以获得较好的生活质量。

Comparison Study of Gastroesophageal Reflux between Retro-and Ante-Aortic Arch Esophagogastrostomies

Aim:To identify difference of occurrance of gastoesophageal reflux after esophagogastrostomy with different type of reconstrution.Clinical material and method:Intraesophageal 24 hour pH monitoring was carried out in 25 patients after esophagectomy.Patients were divided into two groups:group A,esophagectomy with the classical supraaortic arch anastomosis (the stomach was advanced to the thorax) in front of aortic arch and group B,anastomosis lying above the aortic arch with the stomach in the esophageal bed.Result:(1)pH score,number of reflux episodes,number of reflux episodes longer than 5 minutes,the longest reflux episodes and total time of pH below 4 were abnomal in both group A and group B.(2)Number of reflux episodes was similar in two groups,but in group A the other four parameters showed higher values than those in group B.Conclusion:All patients will have gestroesophageal reflux after esophagectomy but the retroaotic arch anactomosis group showed lesser reflux than that of the anteaortic arch anastomosis group.