经胃黏膜下层食管胃黏膜单层吻合法的抗返流作用研究  

The Effect of Semaphorin 5A on Invasion and Metastasis of Gastric Cancer

作　　者：丁国文[1] 陈锁成[1] 唐巍峰[1] 施益军[1] 孙扬永[1] 朱静峰[1] 顾海勇[1] 邵爱中[1] 

机构地区：[1]江苏大学附属人民医院心胸外科,212002

出　　处：《实用癌症杂志》2013年第1期62-63,72,共3页The Practical Journal of Cancer

摘　　要：目的探讨经胃黏膜下层食管胃黏膜单层吻合的抗返流作用。方法 412例食管下段癌、贲门癌患者,按肿瘤根治要求切除,残胃残端予以闭合器关闭,胃体部大弯侧作黏膜下隧道,长3.0 cm,宽3.0 cm;游离食管末端黏膜层,食管黏膜穿入胃壁隧道内与胃黏膜层吻合,食管肌层与隧道入口处胃壁浆肌层间断缝合,隧道出口胃壁浆肌层切口间断缝合关闭隧道。结果无吻合口瘘、吻合口狭窄发生,2例有少量反酸,其中68例患者行纤维胃镜检查:吻合口上3～4 cm处食管呈关闭状态,黏膜无充血水肿及糜烂,血管纹理清晰。食管黏膜活检按Menin氏标准分级:0、Ⅰ、Ⅱ级分别有10例(14.7%)、47例(69.1%)和11例(16.2%),无Ⅲ级病例。食管液pH值测定,pH值为6.5、7.0、7.5分别有13例(19.1%)、46例(67.7%)和9例(13.2%)。结论经胃黏膜下层食管胃黏膜单层吻合适于病变小的食管癌、贲门癌患者,具有良好地抗返流作用。Objective To investigate the effects of transgastrosubmucosa gastroesophageal mucosa-mucosa anastomosis in preventing gastroesophageal reflux of the stoma.Methods 412 patients with esophageal or cardiac cancer were selected and undergone esophagogastrostomy by transgastrosubmucosa gastroesophageal mucosa-mucosa anastomosis,tumors were removed totally;residual stomach was closed by stapling device.Transgastrosubmucosa tunnel was 3.0 cm×3.0 cm wide,esophageal mucosa at the end of esophagus was free,gastroesophageal mucosa-mucosa anastomosis was conducted through the tunnel under the stomach wall,esophageal muscle layer and stomach seromuscular layer at the tunnel inlet was interrupted sutured,and stomach seromuscular layer at the tunnel outlet was interrupted sutured and tunnel was closed.Results No in-hospital death was observed,no anastomotic stenosis or anastomotic fistula occurred,2 cases were with mild acid reflux.Fiber gastroscope inspections were conducted in 68 patients：the state of esophagus 3-4 cm above anastomotic were closed and no esophageal mucosa edema,congestion or erosion was observed,blood vessels were distinct.Esophageal mucosal biopsies were classified according to Menin＇s standard：level 0,Ⅰ,Ⅱ was observed in 10（14.7%）,47（69.1%） and 11（16.2%） patients respectively,no level Ⅲ was observed.Esophageal pH value was monitored with the results 6.5,7.0 and 7.5 in 13 cases（19.1%）,46 cases（67.7%） and 9 cases（13.2%） respectively.Conclusion Effects of preventing gastroesophageal reflux were remarkable and more definite in transgastrosubmucosa gastroesophageal mucosa-mucosa anastomosis for mild gastric and esophageal cancer patients.

关 键 词：胃黏膜下层 食管胃黏膜单层吻合 胃食管返流 

分 类 号：R735.2[医药卫生—肿瘤]