食管胃结合部腺癌术后食管反流的观察  

Esophageal acid and alkaline exposure in patients of esophagogastric junction adenocarcinoma after proximal gastrectomy or total gastrectomy

作　　者：鉴谧 曲辉[2] 孙国瑞[2] 周鹏[1] 何庆泗[2] 

机构地区：[1]山东大学医学院研究生院,济南250012 [2]山东大学齐鲁医院普外科

出　　处：《中华普通外科杂志》2014年第10期749-752,共4页Chinese Journal of General Surgery

基　　金：山东省自然基金资助项目（Y2008C38）

摘　　要：目的 比较食管胃结合部腺癌全胃切除术后和近端胃切除术后食管酸碱暴露特点.方法 选择2007年9月至2011年9月在山东大学齐鲁医院手术治疗的77例食管胃结合部腺癌,分别于术后采用便携式pH监测仪进行食管24 h pH监测,对比分析不同手术后食管酸碱暴露的特点.结果 本组77例患者中行全胃切除术25例,行近端胃切除术加幽门成形术33例,单纯行近端胃切除术19例.单纯行近端胃切除组酸反流总次数、超过5 min的酸反流次数、最长的酸反流时间（min）、pH ＜4.00的总时间和DeMeester积分均高于近端胃切除术加幽门成形术组（U=32,P＜0.01;U =35,P＜0.01;U=23,P＜0.01;U=39,P＜0.01;U=49,P＜0.01）,全胃切除组所有病例仅显示碱性反流（pH ＞7.00）.近端胃切除术加幽门成形术组碱反流总次数低于全胃切除组（U=52,P＜0.01）和单纯行近端胃切除组（U=182,P＜0.05）,而近端胃切除术加幽门成形术组最长碱反流时间、pH ＞7.00总时间均长于全胃切除组（U=125,P＜0.01;U=143.5,P＜0.01）和单纯行近端胃切除组（U =23.5,P＜0.01;U=14,P＜0.01）.结论 近端胃切除术中行幽门成形术后碱性反流比较严重.幽门成形术可能加重碱性反流并且不会减轻酸性反流.全胃切除术和不行幽门成形的近端胃切除术治疗食管胃结合部腺癌在阻止碱性反流方面效果更优.Objective To compare the esophageal acid and alkaline exposure characteristics of patients with cardia carcinoma after proximal gastrectomy or total gastrectomy.Method A total of 77 patients of cardia carcinoma who underwent radical resection from Sep 2007 to Sep 2011 in our hospital were retrospectively reviewed.24 hour esophageal pH monitoring were performed in all patients.Result Patients were divided into three groups：group TG had total gastrectomy （n =25）,group PP had proximal gastrectomy with pyloroplasty （n =33）,group NP had proximal gastrectomy （n =19）.It revealed that indicators of acid reflux including the overall time length of acid episodes,＞ 5 min times of acid episodes,duration of longest acid episodes,time length of pH ＜ 4.00 and the DeMeester Scores in group NP were significantly higher than in group PP（U =32,P ＜ 0.01 ; U =35,P ＜ 0.01 ; U =23,P ＜ 0.01 ; U =39,P ＜0.01 ;U =49,P ＜0.01 respectively）.Only alkline reflux was observed in group TG.The total times of alkaline episodes in PP group was significantly lower than in group TG（U =52,P ＜0.01） and group NP （U =182,P ＜0.01）.＞5 min times of alkaline episodes in group TG was larger than in group PP,and that in group PP was larger than in group NP（P ＜0.01）.Duration of longest alkaline episodes and total period of pH ＞7.00 in group PP was significantly higher than in group TG（U =125,P ＜ 0.01 ; U =143.5,P ＜ 0.01）,and that in group TG was higher than in group NP（U =23.5,P ＜ 0.01 ; U =14,P ＜ 0.01）.Conclusions Alkaline reflux deserves more attention in evaluating esophageal reflux in patients with cardia carcinoma after resection.Pyloroplasty is not helpful to relieving esophageal acid episodes while causing severe alkaline reflux.

关 键 词：胃肿瘤 胃食管反流 食管PH监测 胃切除术 

分 类 号：R735[医药卫生—肿瘤]