CAJ | 학술논문

目的通过监测食管癌手术前后不同吻合口平面压力、24h pH值变化,探讨吻合口平面与胃食管反流关系.方法 2011年6月至2012年3月期间45例术前确诊为食管癌的患者行食管癌手术,其中男30例,女15例;中位年龄63岁.既往均无反酸、烧心等症状.根据国际抗癌联盟(UICC2009)食管癌分段标准,分为食管胸上段癌组、中段癌组和下段癌组,每组15例.分别监测手术前后食管腔内压力、食管湿咽蠕动振幅、24h pH值.结果组间比较,术前食管胸上段癌组、中段癌组和下段癌组患者食管下括约肌压力分别为(25.45±10.61) mmHg(1 mmHg=0.133 kPa)、(27.11±9.92) mmHg和(26.34±8.87)mmHg;食管湿咽蠕动振幅分别为(95.10±18.76) mmHg、(94.24±20.65) mmHg和(97.43±22.20) mmHg;食管24 h pH值＜4总时间占比分别为(2.35±1.27)％、(1.94士1.46)％和(2.09±1.54)％,差异均无统计学意义(P＞0.05).术后吻合口平面压力分别为(4.18±2.67) mmHg、(3.98±3.14) mmHg和(4.29±3.26) mmHg,P＞0.05.术后残余食管湿咽蠕动振幅分别为(15.52±10.23)mmHg、(24.52±12.42) mmHg和(32.48±9.68) mmHg;残余食管24 h pH值＜4总时间占比分别为(23.94±2.76)％、(15.20±1.68)％和(10.31±2.04)％,差异均有统计学意义(P＜0.05).组内比较,手术前后患者食管腔内压力、食管湿咽蠕动振幅、食管24 h pH值＜4总时间占比差异均有统计学意义(P＜0.05).结论食管癌手术在彻底切除食管肿瘤的前提下,应尽量保留正常食管,减少术后吞咽不适应和胃食管反流发生.
목적 통과감측식관암수술전후불동문합구평면압력、24h pH치변화,탐토문합구평면여위식관반류관계.방법 2011년6월지2012년3월기간45례술전학진위식관암적환자행식관암수술,기중남30례,녀15례;중위년령63세.기왕균무반산、소심등증상.근거국제항암련맹(UICC2009)식관암분단표준,분위식관흉상단암조、중단암조화하단암조,매조15례.분별감측수술전후식관강내압력、식관습인연동진폭、24h pH치.결과 조간비교,술전식관흉상단암조、중단암조화하단암조환자식관하괄약기압력분별위(25.45±10.61) mmHg(1 mmHg=0.133 kPa)、(27.11±9.92) mmHg화(26.34±8.87)mmHg;식관습인연동진폭분별위(95.10±18.76) mmHg、(94.24±20.65) mmHg화(97.43±22.20) mmHg;식관24 h pH치＜4총시간점비분별위(2.35±1.27)％、(1.94사1.46)％화(2.09±1.54)％,차이균무통계학의의(P＞0.05).술후문합구평면압력분별위(4.18±2.67) mmHg、(3.98±3.14) mmHg화(4.29±3.26) mmHg,P＞0.05.술후잔여식관습인연동진폭분별위(15.52±10.23)mmHg、(24.52±12.42) mmHg화(32.48±9.68) mmHg;잔여식관24 h pH치＜4총시간점비분별위(23.94±2.76)％、(15.20±1.68)％화(10.31±2.04)％,차이균유통계학의의(P＜0.05).조내비교,수술전후환자식관강내압력、식관습인연동진폭、식관24 h pH치＜4총시간점비차이균유통계학의의(P＜0.05).결론 식관암수술재철저절제식관종류적전제하,응진량보류정상식관,감소술후탄인불괄응화위식관반류발생.
Objective To explore the relationship between the anastomotic plane and gastric esophageal reflux by analysizing three different anastomotic plan pressure and esophageal 24 h dynamic pH.Methods From June 2011 to March 2012, 45 patients with esophageal cancer had undergone radical surgery.According to the different locations of esophageal carcinoma, we divided patients into three groups(cervical esophagogastrostomy group, above aortic arches for esophagogastrostomy group, low aortic arches for esophagogastrostomy group).we monitored the LESP, esophageal wet swallowing peristalsis amplitude and 24 h dynamic pH value two days before surgery, and monitored the anastomotic plane pressure, residual esophageal wet swallowing peristalsis amplitude and 24 h dynamic pH value 1 month and 2 months after surgery in the same way.Results Three groups' difference of LESP, esophageal wet swallowing peristalsis amplitude and percentage of total time of 24 h dynamic pH ＜4in preoperative was not statistically significant.The difference of esophagogastrostomy plane pressure in postoperative was not statistically significant, but the wet swallowing peristalsis amplitude and percentage of total time of 24 h dynamic pH ＜ 4 in postoperative was statistically significant.Three groups' difference of LESP(compared with esophagogastrostomy plane pressure), wet swallowing peristalsis amplitude and percentage of total time of 24 h dynamic pH ＜ 4 between preoperative and postoperative was also statistically significant.Conclusion For patients with esophageal neoplasms, we should completely resection the tumor, and remain esophagus as much as possible.