保留迷走神经的食管贲门癌切除胃底重建术后胃功能研究

目的 研究保留迷走神经的食管、贲门癌切除并胃底重建术后胃功能的变化，以探讨其应用前景。方法 对68例无外侵的早、中期食管和贲门癌患者施行根治性切除，术中保留迷走神经加胃底重建（观察组）；随机选择68例未保留迷走神经、未加胃底重建的常规手术者作对照组。术后观察对比两组患者手术前后的自觉症状和电子胃镜检查结果及上消化道压力、24h胃pH值及基础胃酸分泌量、胃排空时间、血清胃泌素含量检测结果。结果 （1）临床症状：在厌食、嗳气、反流、烧心、恶心、腹泻、餐后饱胀感方面，观察组患者较对照组明显改善（P〈0．01）。（2）24h胃pH值、基础胃酸分泌量、空腹血清胃泌素和胸腔胃排空检测结果：观察组手术前、后比较差异无统计学意义。术后1个月与术前比较，均P〉0．05；术后1年与术前比较，也均P〉0．05。（3）上消化道压力：观察组吻合口上方食管静息压增加，术后1个月和1年时与术前比较，P〈0．01；而对照组则没有增加，术后1个月和1年时与术前比较，P〉0．05；观察组吻合口上方食管体部收缩压高于对照组，术后1个月和1年时与对照组比较，P〈0．05。（4）观察组患者术后胃萎缩性胃炎和反流性食管炎的发生率与对照组比较，明显降低（P〈0．01）。结论 对于早期无周围外侵的食管贲门癌患者保留迷走神经的食管、贲门癌切除并胃底重建术能防止术后胃的消化功能紊乱。

Study of gastric function after esophagectomy and cardiectomy with vagus nerve preserved and reconstruction of gastric funds in patients with esophageal and cardiac cancer

Objective To study the gastric function after esophagectomy and cardiectomy with vagus nerve preserved and reconstruction of gastric funds (VPRG)in patients with esophageal cancer(EC) and cardiac cancer(CC). Methods Sixty-eight patients with early or middle staged EC or CC received esophagectomy and cardiectomy with vagus nerve preserved and reconstruction of gastric funds(VPRG),while other 68 patients esophagectomy and cardiectomy with vagus nerve severed and no reconstruction of gastric funds(VSNG) as control. The symptoms,the pressure of the residual esophagus and thoracic stomach,24-hour pH monitoring,mean basic gastric acid output,gastric emptying time of the intrathoracic stomach,fasting serum gastrin level,fibroptic endoscopic results were compared before and after operation between the two groups. Results The patients with VPRG had less symptoms after operation than those with VSNG such as anorexia,belch,reflux,heartburn,nausea,diarrhea,postcibal satiety(P< 0.01). In VPRG group,compared with the results before operation,there were no significant differences in 24-hour pH monitoring,the mean basic gastric acid output,the fasting serum gastrin level,the gastric emptying time of intrathoracic stomach one month and one year after operation(both P >0.05). The pressure of the residual esophagus above the anastomosis in VPRG group was significantly higher than that in VSNG group(both P< 0.05). Fibroptic endoscopic examination revealed higher incidences of postoperative atrophic gastritis and reflux esophagitis in VPRG group one month and one year after operation than those in VSNG group(P< 0.01). Conclusion Preservation of the vagus nerve and reconstruction of gastric funds after esophagectomy and cardiectomy for esophageal and cardiac cancer can prevent digestive disorder and improve the life quality of the patients.