翻转法机械吻合加Nissen胃底折叠术在食管胃主动脉弓下吻合中的抗反流作用  

Anti-reflux effects of reverse stapling with Nissen fnndoplication for esophagogastric anastomoses

作　　者：务森[1] 陈明耀[1] 魏立[1] 陈重[1] 

机构地区：[1]河南省人民医院胸部肿瘤中心,郑州450003

出　　处：《中华医学杂志》2011年第47期3350-3353,共4页National Medical Journal of China

摘　　要：目的探讨翻转法机械吻合加Nissen胃底折叠术在食管胃主动脉弓下吻合中的抗反流作用。方法回顾性调查河南省人民医院胸部肿瘤中心2009年7月至2010年12月共103例食管胸下段癌及食管胃交界癌患者行翻转法机械吻合加Nissen胃底折叠术（试验组）的情况，与同期常规食管胃机械吻合术130例（常规组）对比手术情况及术后吻合口愈合、胃食管反流程度等。结果手术吻合时间试验组为（16．4±2．0）min，常规组为（14．0±1．8）min（t=-9．38，P〈0．01）。两组均无吻合口瘘发生。术后并发症试验组为13例，常规组为23例（X^2=1．13，P=0．36）。吻合口狭窄率试验组为4．8％（5／103），常规组为6．9％（9／130），组间差异无统计学意义（X^2=0．44，P=o．58）。吻合口炎发生率试验组为17．4％（18／103），常规组为17．7％（23／130），组间差异无统计学意义（X^2=0．002，P=0．96）。胃镜提示反流性食管炎发生率分别为试验组15．5％（16／103）和常规组22．3％（29／130），组间差异无统计学意义（r=2．57，P=0．46）。应用胃食管反流问卷GerdQ调查反流症状（以总分≥8分为诊断标准），试验组32／103例（31．1％），常规组64／130例（49．2％），两组对比差异有统计学意义（r=7．825，P：0，007）。结论翻转法机械吻合加Njssen胃底折叠术操作简便并具有显著的抗反流作用，推荐在食管胃主动脉弓下吻合中使用。Objective To explore the anti-reflux effects of esophagogastric anastomoses by reverse stapling with Nissen fundoplication （RSNF）. Methods A total of 103 cases of lower esophageal carcinomas and esophagogastric junction carcinomas undergone reverse stapled anastomoses with Nissen fundoplication between July 2009 and December 2010 at our hospital were retrospectively reviewed. And fistula, stricture and gastroesophageal reflux were compared with those of 130 traditional cases. Results RSNF required more time than the traditional group （ 16.42 vs 14. 02 rain, P 〈 0. 001 ） . No fistula was found in neither group. There were 13 complications in RSNF and 23 in the traditional group （X2 = 0. 44, P = 0. 58 ）. The rate of stricture was 4. 8% （5/103）in RSNF and 6. 9% （9/130）in the traditional group （X2 = 0.44, P = 0. 58 ）. There were 16 reflux esophagitis （15. 5% ） in RSNF and 29 in the traditional group （22. 3% ） （X2 = 2. 57, P = 0.46）. The post-RSNF reflux symptoms were more severe than the traditional group （31.1% vs 49. 2%, X2 = 7. 825, P = 0. 007, score of GerdQ 〉 8 ） . Conclusion Reverse stapling with Nissen fundoplication may be conveniently performed with definite anti-reflux effects for esophagogastric anastomoses.

关 键 词：吻合术 外科 食管切除术 胃食管反流 

分 类 号：R735[医药卫生—肿瘤]