食管胃壁内吻合术对抗反流作用的临床研究

目的 探讨食管胃壁内吻合术重建贲门功能对预防食管下段癌、食管胃交界癌术后反流性食管炎的作用.方法 回顾性分析2002年1月至2008年10月西安交通大学医学院第二附属医院对66例食管下段癌、食管胃交界癌患者(研究组)施行胸腔食管胃壁内吻合术的临床资料.同期行器械吻合的65例患者为对照组.两组术后情况进行比较,采用X~2和t检验统计分析.结果 (1)反流程度:研究组3例为Ⅰ度,63例为0度;对照组16例为0度,23例为Ⅰ度,19例为Ⅱ度,7例为Ⅲ度.两组比较差异有统计学意义(X~2=137.3,P<0.05).(2)钡餐透视:研究组12例有少量钡剂反流,对照组有41例钡剂反流,两组比较差异有统计学意义(X~2=27.4,P<0.05).(3)胃镜检查:研究组9例黏膜改变,对照组46例黏膜改变,两组比较差异有统计学意义(X~2=43.5,P<0.05).(4)食管括约肌压力:研究组食管下括约肌压力为(3.4±0.8)kPa,食管上括约肌压力为(7.4±1.7)kPa;对照组分别为(2.5±0.6)kPa、(4.2±0.8)kPa.两组比较差异有统计学意义(t=4.98,11.59,P<0.05).结论 食管胃壁内吻合术能够部分达到贲门功能重建的作用,可较好预防反流性食管炎的发生.

Effects of esophagogastric intramural anastomosis on the prevention of reflux esophagitis

Objective To investigate the effects of esophagogastric intramural anastomosis on preventing reflux esophagitis by restoring the cardiac function after esophagectomy.Methods The clinical data of 66 esophagem or cardiac cancer patients(test group)who received esophagogastrie intramural anastomosis at Second Affiliated Hospital of Xi'an Jiaotong University from January 2002 to October 2008 were retrospectively analyzed.Sixty-five patients who received stapled anastomosis during the same period were in control group.Postoperative conditions of patients in the 2 groups were compared by chi-square test and t test.Results (1)Reflux condition:there were 3 patients with degree I and 63 without reflux in test group,and 23 with degree Ⅰ,19 with degree Ⅱ,7 with degree Ⅲ and 16 without reflux in control group.There was a significant difference between the 2 groups(X~2=137.3,P<0.05);(2)results of barium meal fluoroscopy:12 patients in test group and 41 patients in control group had barium reflux,with significant difference between the 2 groups(X~2=27.4,P<0.05);(3)results of gastroscopy:9 patients in test group and 46 patients in control group had morphological changes of mucosa,with significant difference between the 2 groups(X~2=43.5,P<0.05);(4)esophageal sphincter pressure:the pressure of lower esophageal sphincter was(3.4±0.8)kPa in test group and(2.5±0.6)kPa in control group,and the pressure of upper esophageal sphincter wag(7.4±1.7)kPa in test group and(4.2±0.8)kPa in control group.There was a significant difference in esophageal sphincter pressure between the 2 groups(t=4.98,11.59,P<0.05).Conclusion Esophagogastric intramural anastomosis can partly restore the cardiac function and prevent reflux esophagitis effectively.