经食管床吻合术后对残余食管的压力测定和酸碱度分析  

Esophageal manometry and 24-hour pH monitoring in the remnant esophagus after esophagectomy and esophagogastric anastomosis following esophageal bed

作　　者：姜志良[1] 杨继武[1] 王林[1] 李建新[1] 

机构地区：[1]大连大学附属中山医院胸心血管外科,116001

出　　处：《中华胃肠外科杂志》2008年第1期32-35,共4页Chinese Journal of Gastrointestinal Surgery

基　　金：辽宁省教育厅研究基金资助（05L022）

摘　　要：目的探讨食管癌切除胃经食管床主动脉弓上吻合术后，食管、胃功能改变及胃食管反流的情况。方法对20例食管中段癌术后3-6个月患者（研究组）及10例正常人（对照组）采用食管胃压力测定及24h食管酸碱度（pH）监测，并对结果进行分析。结果（1）研究组各项pH监测指标均明显高于对照组（P〈0．01）。（2）胃静息压、残余食管静息压及食管上括约肌静息压研究组均高于对照组（P〈0．01）；残余食管收缩压、食管原发蠕动幅度及食管湿蠕动幅度均低于对照组（P〈0．01）；食管上括约肌关闭压高于对照组（P〈0．01）；胃、吻合口及残余食管静息压三处两两比较，差异均无统计学意义（F=3．08，P〉0．05）。结论经食管床主动脉弓上食管胃吻合术后，残余食管蠕动功能差，廓酸能力降低；吻合口处不存在高压带，普遍存在胃食管反流现象。Objective To investigate the motility function of remnant esophagus and stomach, and the gastreesophageal reflux after esophagectomy and esophagogastric anastomosis following esophageal bed. Methods Esophageal manometry and 24-hour pH monitoring were pedormed in 10 healthy volunteers and 20 patients who underwent esophagectomy and esophagogastric anastomosis through esophageal bed as a treatment for mid-esophageal carcinoma. These 20 patients, received examinations within 3 to 6 months after operations, were definded as study group, and 10 healthy volunteers as control group. Results （1）All the pH monitoring indexes in study group were significantly higher than those in control group （P〈0.01）. （2）Rest pressures of stomach, remnant esophagus and upper esophageal sphincter significantly increased in comparison with control group （P〈0.01）. （3）The contracting pressure, amplitude of primary peristalsis and amplitude of swallow peristalsis of remnant esophagus were reduced as compared to control group（P〈0.01）. （4）The contraction pressure of upper esophageal sphincter was obviously higher than that of control group （P〈0.01）. （5） There were no significant differences among stomach rest pressure, anastomosis rest pressure and remnant esophagus rest pressure in study group （F=3.08,P〉0.05）. Conclusions After esophagectomy and esophagogastric anastomosis through esophageal bed in upper aortic site, the peristalsis function of remnant esophagus is poor, the function of acid clearance is reduced, no high pressure zone at the anastomosis orifice is found, the anastomosis orifice has no anti-reflux effect, and gastreesophageal reflux exists in the postoperative patients prevalently.

关 键 词：食管肿瘤 食管床 胃食管反流 食管PH监测 食管测压 

分 类 号：R735[医药卫生—肿瘤]