Domergue J, Veyrac M, Huin-Yan S, Rouanet P, Collet H, Michel H, Pujol H
Montpellier Cancer Institute, France.
Surg Gynecol Obstet. 1990 Aug;171(2):107-10.
Gastroesophageal reflux is the main complaint after intrathoracic gastroplasty for carcinoma of the esophagus. Eighteen patients who underwent intrathoracic gastroplasty were studied by 24 hour pH monitoring. Two groups of patients were separately evaluated according to the surgical procedure performed--group 1, nine patients with tubulized stomach and gastroesophageal anastomosis at the apex of the thorax, and group 2, nine patients without tubulized stomach and with low gastroesophageal anastomosis. Gastroesophageal reflux and gastric function were analyzed. Gastroesophageal reflux was clinically present in 36 per cent of patients. During the 24 hour pH monitoring period, the percentage of time that the esophageal electrode showed a pH value of less than 4 was shorter for group 1 than for group 2 (13.3 +/- 11.3 versus 32.7 +/- 21.7), indicating less gastroesophageal reflux. Gastric secretion was also studied with 24 hour pH monitoring. Gastric secretion was reduced after gastroplasty, compared with a control group. Gastric secretion was identical between groups 1 and 2. Tubulization did not impair gastric secretion. Findings from this study show that good functional results can be achieved after intrathoracic gastroplasty if the anastomosis is performed on the neck or at the apex of the thorax. This technique can reduce gastroesophageal reflux without an antireflux procedure.
胃食管反流是食管癌胸内胃成形术后的主要问题。对18例行胸内胃成形术的患者进行了24小时pH监测研究。根据所施行的手术方式将患者分为两组——第1组，9例采用管状胃并在胸顶部进行胃食管吻合术；第2组，9例未采用管状胃且行低位胃食管吻合术。分析了胃食管反流和胃功能。36%的患者临床上存在胃食管反流。在24小时pH监测期间，第1组食管电极显示pH值小于4的时间百分比短于第2组（13.3±11.3对32.7±21.7），表明胃食管反流较少。还通过连续24小时pH监测研究了胃液分泌情况。与对照组相比，胃成形术后胃液分泌减少。第1组和第2组之间胃液分泌情况相同。胃管化未损害胃液分泌。本研究结果表明，如果在颈部或胸顶部进行吻合术，胸内胃成形术后可取得良好的功能效果。该技术无需抗反流手术即可减少胃食管反流。
