CAJ | 학술논문

目的探讨食管中段癌切除术后食管胃吻合附加改良Nissen折叠术的抗反流作用.方法将82例食管中段癌患者按随机数字表法分为两组,分别采用食管癌切除常规吻合器吻合(对照组,41例)和常规器械吻合基础上附加改良Nissen折叠术(观察组,41例).术后3个月,对两组患者进行EORTC QLQ-C30问卷调查,并进行食管测压及内镜检查.结果两组患者术后并发症发生率比较差异无统计学意义(P＞0.05),无围手术期死亡.观察组烧心和胃液反流评分[分别为(13.2±6.1),(16.9±3.9)分]明显低于对照组[分别为(25.6±7.2),(26.6±4.2)分],差异有统计学意义(P＜0.05),而吞咽困难评分两组比较差异无统计学意义(P＞0.05).观察组吻合部位静息压[(3.5±2.3)mmHg,1 mmHg =0.133 kPa]高于胃内压[(2.7±2.1)mmHg],差异有统计学意义(P＜0.05).观察组DeMeester评分为(54±32)分,低于对照组的(141±84)分,差异有统计学意义(P＜0.05).观察组的反流性食管炎发生率为48.8％(20/41),要明显低于对照组的75.6％(31/41),差异有统计学意义(P＜0.05).结论食管胃吻合附加改良Nissen折叠术可增加吻合部位的压力,具有降低胃食管反流、减轻反流性食管炎和胃食管反流症状的作用.
목적 탐토식관중단암절제술후식관위문합부가개량Nissen절첩술적항반류작용.방법 장82례식관중단암환자안수궤수자표법분위량조,분별채용식관암절제상규문합기문합(대조조,41례)화상규기계문합기출상부가개량Nissen절첩술(관찰조,41례).술후3개월,대량조환자진행EORTC QLQ-C30문권조사,병진행식관측압급내경검사.결과 량조환자술후병발증발생솔비교차이무통계학의의(P＞0.05),무위수술기사망.관찰조소심화위액반류평분[분별위(13.2±6.1),(16.9±3.9)분]명현저우대조조[분별위(25.6±7.2),(26.6±4.2)분],차이유통계학의의(P＜0.05),이탄인곤난평분량조비교차이무통계학의의(P＞0.05).관찰조문합부위정식압[(3.5±2.3)mmHg,1 mmHg =0.133 kPa]고우위내압[(2.7±2.1)mmHg],차이유통계학의의(P＜0.05).관찰조DeMeester평분위(54±32)분,저우대조조적(141±84)분,차이유통계학의의(P＜0.05).관찰조적반류성식관염발생솔위48.8％(20/41),요명현저우대조조적75.6％(31/41),차이유통계학의의(P＜0.05).결론 식관위문합부가개량Nissen절첩술가증가문합부위적압력,구유강저위식관반류、감경반류성식관염화위식관반류증상적작용.
Objective To investigate the antireflux effect of esophagogastrostomy combined with modified Nissen fundoplication after esophageal middle cancer resection.Methods Eighty-two patients with esophageal middle cancer were divided into 2 groups by random digits table method,41 cases underwent esophagogastrostomy with a stapler only (control group),41 cases underwent esophagogastrostomy with stapler combined with modified Nissen undoplication (observation group).Three months after surgery,the patients of the 2 groups completed the research of EORTC QLQ-C30 questionnaire,and examined with esophageal manometry and gastroscopy.Results There was no statistical difference in incidence of postoperative complication between the 2 groups (P ＞ 0.05),death was not found during peroperative period.The scores of heart burn and regurgitation in observation group [(13.2 ± 6.1) and (16.9 ± 3.9) scores] were significantly lower that those in control group [(25.6 ± 7.2) and (26.6 ± 4.2) scores],there were statistical differences (P ＜ 0.05),but there was no statistical difference in score of dysphagia between the 2 groups (P ＞ 0.05).The resting pressure of anastomotic site in observation group [(3.5 ± 2.3) mmHg,1 mmHg =0.133 kPa] was significantly higher than that in the stomach [(2.7 ± 2.1) mmHg],there was statistical difference (P＜ 0.05).The DeMeester score was (54 ± 32) scores,control group was (141 t 84) scores,there was statistical difference (P ＜ 0.05).The incidence of reflux esophagitis in observation group was 48.8％(20/41),in control group was 75.6％(31/41),there was statistical difference (P ＜ 0.05).Conclusions Esophagogastrostomy combined with modified Nissen fundoplication after esophageal middle cancer resection significantly increases the pressure at the anastomotic site,thus reduces the extent of gastroesophageal reflux,which leads to the reduction of the extent of reflux esophagitis and the improvement of the quality of life.