中华普通外科杂志
中華普通外科雜誌
중화보통외과잡지
CHINESE JOURNAL OF GENERAL SURGERY
2014年
10期
749-752
,共4页
鉴谧%曲辉%孙国瑞%周鹏%何庆泗
鑒謐%麯輝%孫國瑞%週鵬%何慶泗
감밀%곡휘%손국서%주붕%하경사
胃肿瘤%胃食管反流%食管pH监测%胃切除术
胃腫瘤%胃食管反流%食管pH鑑測%胃切除術
위종류%위식관반류%식관pH감측%위절제술
Stomach neoplasms%Gastroesophageal reflux%Esophageal pH monitoring%Gastrectomy
目的 比较食管胃结合部腺癌全胃切除术后和近端胃切除术后食管酸碱暴露特点.方法 选择2007年9月至2011年9月在山东大学齐鲁医院手术治疗的77例食管胃结合部腺癌,分别于术后采用便携式pH监测仪进行食管24 h pH监测,对比分析不同手术后食管酸碱暴露的特点.结果 本组77例患者中行全胃切除术25例,行近端胃切除术加幽门成形术33例,单纯行近端胃切除术19例.单纯行近端胃切除组酸反流总次数、超过5 min的酸反流次数、最长的酸反流时间(min)、pH ＜4.00的总时间和DeMeester积分均高于近端胃切除术加幽门成形术组(U=32,P＜0.01;U =35,P＜0.01;U=23,P＜0.01;U=39,P＜0.01;U=49,P＜0.01),全胃切除组所有病例仅显示碱性反流(pH ＞7.00).近端胃切除术加幽门成形术组碱反流总次数低于全胃切除组(U=52,P＜0.01)和单纯行近端胃切除组(U=182,P＜0.05),而近端胃切除术加幽门成形术组最长碱反流时间、pH ＞7.00总时间均长于全胃切除组(U=125,P＜0.01;U=143.5,P＜0.01)和单纯行近端胃切除组(U =23.5,P＜0.01;U=14,P＜0.01).结论 近端胃切除术中行幽门成形术后碱性反流比较严重.幽门成形术可能加重碱性反流并且不会减轻酸性反流.全胃切除术和不行幽门成形的近端胃切除术治疗食管胃结合部腺癌在阻止碱性反流方面效果更优.
目的 比較食管胃結閤部腺癌全胃切除術後和近耑胃切除術後食管痠堿暴露特點.方法 選擇2007年9月至2011年9月在山東大學齊魯醫院手術治療的77例食管胃結閤部腺癌,分彆于術後採用便攜式pH鑑測儀進行食管24 h pH鑑測,對比分析不同手術後食管痠堿暴露的特點.結果 本組77例患者中行全胃切除術25例,行近耑胃切除術加幽門成形術33例,單純行近耑胃切除術19例.單純行近耑胃切除組痠反流總次數、超過5 min的痠反流次數、最長的痠反流時間(min)、pH ＜4.00的總時間和DeMeester積分均高于近耑胃切除術加幽門成形術組(U=32,P＜0.01;U =35,P＜0.01;U=23,P＜0.01;U=39,P＜0.01;U=49,P＜0.01),全胃切除組所有病例僅顯示堿性反流(pH ＞7.00).近耑胃切除術加幽門成形術組堿反流總次數低于全胃切除組(U=52,P＜0.01)和單純行近耑胃切除組(U=182,P＜0.05),而近耑胃切除術加幽門成形術組最長堿反流時間、pH ＞7.00總時間均長于全胃切除組(U=125,P＜0.01;U=143.5,P＜0.01)和單純行近耑胃切除組(U =23.5,P＜0.01;U=14,P＜0.01).結論 近耑胃切除術中行幽門成形術後堿性反流比較嚴重.幽門成形術可能加重堿性反流併且不會減輕痠性反流.全胃切除術和不行幽門成形的近耑胃切除術治療食管胃結閤部腺癌在阻止堿性反流方麵效果更優.
목적 비교식관위결합부선암전위절제술후화근단위절제술후식관산감폭로특점.방법 선택2007년9월지2011년9월재산동대학제로의원수술치료적77례식관위결합부선암,분별우술후채용편휴식pH감측의진행식관24 h pH감측,대비분석불동수술후식관산감폭로적특점.결과 본조77례환자중행전위절제술25례,행근단위절제술가유문성형술33례,단순행근단위절제술19례.단순행근단위절제조산반류총차수、초과5 min적산반류차수、최장적산반류시간(min)、pH ＜4.00적총시간화DeMeester적분균고우근단위절제술가유문성형술조(U=32,P＜0.01;U =35,P＜0.01;U=23,P＜0.01;U=39,P＜0.01;U=49,P＜0.01),전위절제조소유병례부현시감성반류(pH ＞7.00).근단위절제술가유문성형술조감반류총차수저우전위절제조(U=52,P＜0.01)화단순행근단위절제조(U=182,P＜0.05),이근단위절제술가유문성형술조최장감반류시간、pH ＞7.00총시간균장우전위절제조(U=125,P＜0.01;U=143.5,P＜0.01)화단순행근단위절제조(U =23.5,P＜0.01;U=14,P＜0.01).결론 근단위절제술중행유문성형술후감성반류비교엄중.유문성형술가능가중감성반류병차불회감경산성반류.전위절제술화불행유문성형적근단위절제술치료식관위결합부선암재조지감성반류방면효과경우.
Objective To compare the esophageal acid and alkaline exposure characteristics of patients with cardia carcinoma after proximal gastrectomy or total gastrectomy.Method A total of 77 patients of cardia carcinoma who underwent radical resection from Sep 2007 to Sep 2011 in our hospital were retrospectively reviewed.24 hour esophageal pH monitoring were performed in all patients.Result Patients were divided into three groups:group TG had total gastrectomy (n =25),group PP had proximal gastrectomy with pyloroplasty (n =33),group NP had proximal gastrectomy (n =19).It revealed that indicators of acid reflux including the overall time length of acid episodes,＞ 5 min times of acid episodes,duration of longest acid episodes,time length of pH ＜ 4.00 and the DeMeester Scores in group NP were significantly higher than in group PP(U =32,P ＜ 0.01 ; U =35,P ＜ 0.01 ; U =23,P ＜ 0.01 ; U =39,P ＜0.01 ;U =49,P ＜0.01 respectively).Only alkline reflux was observed in group TG.The total times of alkaline episodes in PP group was significantly lower than in group TG(U =52,P ＜0.01) and group NP (U =182,P ＜0.01).＞5 min times of alkaline episodes in group TG was larger than in group PP,and that in group PP was larger than in group NP(P ＜0.01).Duration of longest alkaline episodes and total period of pH ＞7.00 in group PP was significantly higher than in group TG(U =125,P ＜ 0.01 ; U =143.5,P ＜ 0.01),and that in group TG was higher than in group NP(U =23.5,P ＜ 0.01 ; U =14,P ＜ 0.01).Conclusions Alkaline reflux deserves more attention in evaluating esophageal reflux in patients with cardia carcinoma after resection.Pyloroplasty is not helpful to relieving esophageal acid episodes while causing severe alkaline reflux.
