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目的评价兜底式食管胃吻合术对吻合口瘘、吻合口狭窄和胃食管反流的预防作用及效果,探讨蒙特利尔定义“胃食管反流病”诊断流程、标准在食管重建术后的实用价值和意义。方法回顾性分析2007年6月至2011年6月笔者医院采用两种术式共行食管癌和贲门癌切除1 078例的临床资料,参考相关诊断标准制表,问卷调查两组患者术后吻合口狭窄和胃食管反流的发病情况。试验组(兜底式食管胃吻合术)582例,男403例、女179例,年龄(60.4±12.6)岁。食管癌399例,贲门癌183例,弓上吻合392例,弓下吻合190例。对照组(传统食管胃端侧吻合术)496例,男343例、女153例,年龄(59.2±12.8)岁。食管癌322例,贲门癌174例,弓上吻合317例,弓下吻合179例。结果与传统食管胃端侧吻合术相比,兜底式吻合术后吻合口瘘的发生率较低[0%(0/582)vs.1.0%(5/496),χ2=5.835,P=0.016)];胃食管反流症状亦较轻,而伴有食管外症状及需要服用制酸剂患者则更少[1.6%(33/541)vs.12.6%(57/453),χ2=23.564,P=0.000],术后吻合口狭窄率各为0.9%(5/539)和7.3%(34/465)(χ2=25.124,P=0.000),尤其是重度吻合口狭窄的发生率更低[0%(0/539)vs.4.7%(22/465),χ2=24.883,P=0.000]。两组5年生存率差异无统计学意义。结论兜底式吻合法在预防食管胃吻合口瘘、吻合口狭窄和胃食管反流的发生方面较传统术式为优;蒙特利尔定义胃食管反流诊断流程和标准适合于食管重建术后胃食管反流之诊断。
Objective To evaluate the prophylactic effect and safety of pocket esophagogastrostomy on anastomotic fistula, anastomotic stenosis and gastroesophageal reflux, and to discuss the definition of “gastroesophageal reflux disease” in Montreal and its application in esophageal reconstruction Value and meaning. Methods Retrospective analysis from June 2007 to June 2011, the author of the hospital using two kinds of surgical resection of esophageal and gastric cardia cancer in 1 078 cases of clinical data, refer to the relevant diagnostic criteria tabulation, questionnaire survey of two groups of patients after anastomosis Stenosis and gastroesophageal reflux disease. There were 582 male and female 403 cases in the test group (esophageal and gastric anastomosis), with 179 females (60.4 ± 12.6 years). Esophageal cancer 399 cases, 183 cases of cardia cancer, bow on the anastomosis of 392 cases, 190 cases of bow anastomosis. Control group (traditional esophagogastric anastomosis) 496 cases, 343 males and 153 females, age (59.2 ± 12.8) years of age. 322 cases of esophageal cancer, cardiac cancer in 174 cases, 317 cases of bow on the anastomosis, arch anastomosis in 179 cases. Results Compared with the conventional esophagogastric anastomosis, the incidence of anastomotic fistula was lower after the anastomosis of the anastomosis [0% (0/582) vs.1.0% (5/496), χ2 = 5.835, P = 0.016 ); Gastroesophageal reflux symptoms were also less severe, with fewer patients with esophageal symptoms and those requiring antacids [1.6% (33/541) vs. 12.6% (57/453), χ2 = 23.564, P = 0.000]. The rates of postoperative anastomotic stenosis were 0.9% (5/539) and 7.3% (34/465) respectively (χ2 = 25.124, P = 0.000) 0% (0/539) vs.4.7% (22/465), χ2 = 24.883, P = 0.000]. There was no significant difference in 5-year survival rate between the two groups. Conclusions Trouser-type anastomosis is superior to traditional surgical methods in preventing esophagogastric anastomotic fistula, anastomotic stenosis and gastroesophageal reflux. Montreal-defined gastroesophageal reflux diagnostic procedures and standards are suitable for gastroesophageal reflux after esophagectomy Flow diagnosis.