食管胃吻合口能否抗胃食管反流  

Can esophagogastric anastomosis prevent gastroesophageal reflux

作　　者：王其彰[1,2] 刘俊峰[1,2] 赵新明 雷建章[1,2] 丛庆文 李文起[1,2] 李保庆[1,2] 王福顺 曹富民[1,2] 张小军 张宏伟[1,2] 张宏磊 

机构地区：[1]河北医科大学第四医院胸外科 [2]河北医科大学电镜室

出　　处：《中华外科杂志》1999年第2期71-73,I003,共4页Chinese Journal of Surgery

摘　　要：目的探讨食管胃吻合手术后吻合口能否起抗反流作用。方法采用多指标检测方法，对１９２例贲门癌切除术后患者进行定量观察，行电子胃镜、食管压力测定、２４小时食管ｐＨ监测、放射性核素检查和电镜检查。结果内镜检查９０２％有异常表现，其发生与术后期间长短无关。食管测压显示食管体部静息压明显高于正常人，胃内压则下降。２４小时食管ｐＨ监测平卧位睡眠患者均显示有反流，半卧位睡眠则否。放射性核素检查显示２／３的患者有异常反流，其发生也与术后时间长短无关。电镜观察可见术后患者食管上皮细胞坏死脱落的形态与正常食管上皮细胞凋亡完全不同。结论（１）贲门癌切除食管胃吻合术后，广泛存在胃食管反流。（２）反流的发生不因术后时间长短而异。（３）有些检测方法未能显示反流，可能是方法学问题。２４小时ｐＨ监测应是最敏感的观察方法。（４）术后半卧位睡眠是预防反流的有效方法。Objective To investigate the possible anti reflux function of esophagogastric anastomosis in the patients after receiving resection of cardiac cancer. Methods One hundred and ninety two patients were studied by video assisted gastroscopy, manometry, 24 h pH esophageal monitoring, radioscintigraphy and scanning electron microscopy. Results Abnormalities were found in 90 2% of patients through endoscopy. Resting pressure in esophageal body was higher than that in normal controls, and in the stomach, lower. Twenty four hour pH monitoring demonstrated that gastroesophageal reflux (GER) did not occur when the patients slept in semireclining position, and occurred in all patients when slept in supine position. Scintigraphic study showed that 2/3 of the patients had reflux, occurrence of which was not affected by the length of postoperative period. Scanning electron microscopic examination showed that degeneration, exfoliation of esophageal mucosal epithelial cell, and derangement of microfold and inflammatory oedema of cytomembrane may be directly caused by refluxate. Conclusions GER exists in the majority of the patients after esophagogastrectomy and esophagogastrostomy for cardiac cancer. The occurrence of GER is not affected by the length of postoperative period. Some detecting methods fail to show the existence of GER, and 24 h pH monitoring is the most reliable method for detecting GER. Sleep in semireclining position is an effective method of preventing GER in postoperative patients.

关 键 词：胃食管反流 食管炎 食管胃吻合术 

分 类 号：R655.4[医药卫生—外科学]