Antireflux Effects of Different Reinforcement Procedure in Mechanical Anastomosis for Esophageal and Cardiac Carcinoma_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

ZHANG Yingguo , CHEN Wenyuan , WANG Junxian , ZHANG Yanshan , JIANG Xiaoping.

Department of Chest Surgery, Wuwei Tumor Hospital of Gansu Province, Wuwei 733000, Gansu Province, China;

Corresponding author：

Keywords：

Esophageal and cardiac carcinoma; Mechanical anastomosis only; Lip reinforcement; His angle reconstruction; Reflux

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ObjectiveTo compare the antireflux effects of lip reinforcement, His angle reconstruction with fundoplication, and mechanical anastomosis only in mechanical anastomosis for esophageal and cardiac carcinoma. MethodsOne hundred and seventysix patients with esophageal or cardiac carcinoma admitted to this hospital between March 2008 and October 2009 were included, which were divided into mechanical anastomosis group (n=42), His angle reconstruction group(n=56), and lip reinforcement group (n=78) according to the sequence of admission. Mechanical anastomosis only, mechanical anastomosis His angle reconstruction with fundoplication, and mechanical anastomosis liptype reinforcement were performed in the corresponding group, respectively. Endoscopy and biopsy were conducted to evaluate the antireflux effects on 3 months after operation. ResultsThere were no differences on the gender, age, tumor location, anastomosis site, and incision among three groups (P gt;0.05). The reflux rates of the mechanical anastomosis group, His angle reconstruction group, and lip reinforcement group were 69.05%, 28.57%, and 14.10%, respectively. The reflux rates in the lip reinforcement group and His angle reconstruction group were significantly lower than those in the mechanical anastomosis group (χ2=37.088, P=0.000; χ2=15.833, P=0.000), moreover, the rate in the lip reinforcement group was significantly lower than that in the His angle reconstruction group (χ2=4.241, P=0.039). There was no anastomotic leakage in the lip reinforcement group and all patients safely discharged from hospital after surgery, only 2 patients had moderately anastomotic stenosis and both of them had good recovery with endoscopic dilatationl. The reflux after operation was independent of anastomosis sites (P gt;0.05). ConclusionBoth liptype reinforcement and His angle reconstruction can improve the ability of antireflux, liptype reinforcement is better and simple to mainpulate.

Citation： ZHANG Yingguo,CHEN Wenyuan,WANG Junxian,ZHANG Yanshan,JIANG Xiaoping.. Antireflux Effects of Different Reinforcement Procedure in Mechanical Anastomosis for Esophageal and Cardiac Carcinoma. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2011, 18(3): 309-312. doi: Copy

1.	朱正纲. 胃癌外科治疗相关问题的基本认识 [J]. 中国普外基础与临床杂志, 2008, 15(1): 13.
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5.	Hu J, Li R, Sun L, et al. Influence of esophageal carcinoma operations on gastroesophageal reflux [J]. Ann Thorac Surg, 2004， 78(1): 298302.
6.	任旭. 返流性食管炎的内镜和病理学诊断及分级 [J]. 世界华人消化杂志, 2000, 8(10): 11271136.
7.	王承伟, 吴霞, 祝玲. 三维适形放射治疗食管癌75例临床疗效分析 [J]. 肿瘤基础与临床, 2007, 20(2): 154156.
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11.	贾涛, 暴静玲, 周磊, 等. 重视胃食管吻合术后返流性食管炎治疗 [J]. 中国肿瘤临床与康复, 2008, 15(4): 384.
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13.	刘俊峰, 王金栋, 张少为, 等. 食管癌与贲门癌患者术后残余食管与胸腔胃功能研究 [J]. 中华医学杂志, 2005, 85(38): 26782681.
14.	Mathew G, Myers JC, Watson DI, et al. Motility across esophageal anastomoses after esophagectomy or gastrectomy [J]. Dis Esophagus, 1999, 12(4): 276282.
15.	陈涛, 田伏洲, 周庆贤. 胃大部切除术后残胃功能性排空障碍12例诊治分析 [J]. 中国普外基础与临床杂志, 2002, 9(1): 4344.
16.	史念珂, 付国舟. 食管癌围手术期胃食管反流pH监测分析及探讨 [J]. 中华胸心血管外科杂志, 1999, 15(3): 132134.
17.	王秋生, 刘隆, 冀涛. 消化道修复与重建的成功典范-腹腔镜手术治疗胃食返流病 [J]. 中国普外基础与临床杂志, 2004, 11(3): 195196.
18.	郑春宁, 孙小川, 孙中伟, 等. 综合抗返流技术在近端胃大部切除术中的临床应用研究 [J]. 中国现代普通外科进展, 2006, 9(3): 179180.
19.	李绍金, 肖大伟, 黄研璇, 等. 胸腔内His角重建预防返流性食管炎 [J]. 实用医技杂志, 2006, 13(9): 1538.
20.	王雷, 杨英祥, 张爱平. 重建His角预防食管癌术后返流的临床研究 [J]. 中华肿瘤杂志, 1998, 20(16): 477.
21.	欧阳励, 唐滨江, 唐建国, 等. 食管癌、贲门癌切除术后胃食管返流的临床分析 [J]. 赣南医学院学报, 2009, 29(1): 7273.
22.	吕高涛, 王华德, 朱长远. 内翻吻合瓣在食管胃吻合术后抗返流中的应用 [J]. 肿瘤防治研究, 2005, 12(9): 707708.
23.	阴兵林, 曾来铎, 匡裕康, 等. 人工胃底折叠重建His角预防贲门癌术后返流30例临床分析 [J]. 陕西医学杂志, 2002, 10(3): 195196.
24.	李国珍, 郭燕玲, 孙培军. 机械加手法防止食管胃吻合口并发症 [J]. 肿瘤防治研究, 2005, 32(2): 127.
25.	林永海. 食管胃浆肌层瓣套入式吻合术治疗贲门癌84例分析 [J]. 中国实用医药, 2008, 3(8): 8485.
26.	施新民, 高俊, 樊天友, 等. 食管癌术后吻合口狭窄的预防 [J]. 现代肿瘤医学, 2005, 13(1): 6869.
27.	洪瑞, 方伟群, 李锐凯, 等. 食管贲门癌切除肠内器械吻合1 201例临床观察 [J]. 河北医药, 2010, 32(12): 15591560.
28.	邵令芳, 王其彰. 新编食管外科学 [M]. 第2版. 石家庄: 河北科学出版社, 2002: 513520.
29.	张勇, 高平, 王胜. 食管、贲门癌切除机械吻合术后反流性食管炎的临床研究 [J]. 宁夏医学杂志, 2009, 31(1): 5152.
30.	魏俊飞. 食管癌术后胃食管反流的临床研究 [J]. 中国民康医学(上半月), 2007, 19(10): 848849.

1. 朱正纲. 胃癌外科治疗相关问题的基本认识 [J]. 中国普外基础与临床杂志, 2008, 15(1): 13.
2. 伍硕允, 叶敏, 马良赟. 机械吻合与食管胃分层吻合术治疗食管和贲门癌的对比研究 [J]. 中华胃肠外科杂志, 2005, 8(4): 367368.
3. 赵雍凡. 食管癌外科值得注意的几个问题 [J]. 四川医学, 2005, 26(1): 12.
4. 付茂勇, 赵雍凡, 阎齐，等. 食管、贲门癌切除食管胃分层吻合术患者生命质量评价 [J]. 中国胸心血管外科临床杂志, 2003, 10(2): 101104.
5. Hu J, Li R, Sun L, et al. Influence of esophageal carcinoma operations on gastroesophageal reflux [J]. Ann Thorac Surg, 2004， 78(1): 298302.
6. 任旭. 返流性食管炎的内镜和病理学诊断及分级 [J]. 世界华人消化杂志, 2000, 8(10): 11271136.
7. 王承伟, 吴霞, 祝玲. 三维适形放射治疗食管癌75例临床疗效分析 [J]. 肿瘤基础与临床, 2007, 20(2): 154156.
8. Yalav E, Ercan S. Reservoir and globetype antireflux surgical techniques in intrathoracic esophagogastrostomies [J]. Dis Esophagus, 2000, 13(4): 282287.
9. 张学凯, 张立新, 王启文, 等. 食管癌、贲门癌152例切除术后胃食管返流分析 [J]. 中国误诊学杂志, 2007, 7(30): 73187319.
10. Soyer T, Karnak I, Tanyel FC, et al. The use of pH monitoring and esophageal manometry in the evaluation of results of surgical therapy for gastroesophageal reflux disease [J]. Eur J Pediatr Surg, 2007, 17(3): 158162.
11. 贾涛, 暴静玲, 周磊, 等. 重视胃食管吻合术后返流性食管炎治疗 [J]. 中国肿瘤临床与康复, 2008, 15(4): 384.
12. Richter JE. Gastrooesophageal reflux disease [J]. Best Pract Res Clin Gastroenterol, 2007, 21(4): 609631.
13. 刘俊峰, 王金栋, 张少为, 等. 食管癌与贲门癌患者术后残余食管与胸腔胃功能研究 [J]. 中华医学杂志, 2005, 85(38): 26782681.
14. Mathew G, Myers JC, Watson DI, et al. Motility across esophageal anastomoses after esophagectomy or gastrectomy [J]. Dis Esophagus, 1999, 12(4): 276282.
15. 陈涛, 田伏洲, 周庆贤. 胃大部切除术后残胃功能性排空障碍12例诊治分析 [J]. 中国普外基础与临床杂志, 2002, 9(1): 4344.
16. 史念珂, 付国舟. 食管癌围手术期胃食管反流pH监测分析及探讨 [J]. 中华胸心血管外科杂志, 1999, 15(3): 132134.
17. 王秋生, 刘隆, 冀涛. 消化道修复与重建的成功典范-腹腔镜手术治疗胃食返流病 [J]. 中国普外基础与临床杂志, 2004, 11(3): 195196.
18. 郑春宁, 孙小川, 孙中伟, 等. 综合抗返流技术在近端胃大部切除术中的临床应用研究 [J]. 中国现代普通外科进展, 2006, 9(3): 179180.
19. 李绍金, 肖大伟, 黄研璇, 等. 胸腔内His角重建预防返流性食管炎 [J]. 实用医技杂志, 2006, 13(9): 1538.
20. 王雷, 杨英祥, 张爱平. 重建His角预防食管癌术后返流的临床研究 [J]. 中华肿瘤杂志, 1998, 20(16): 477.
21. 欧阳励, 唐滨江, 唐建国, 等. 食管癌、贲门癌切除术后胃食管返流的临床分析 [J]. 赣南医学院学报, 2009, 29(1): 7273.
22. 吕高涛, 王华德, 朱长远. 内翻吻合瓣在食管胃吻合术后抗返流中的应用 [J]. 肿瘤防治研究, 2005, 12(9): 707708.
23. 阴兵林, 曾来铎, 匡裕康, 等. 人工胃底折叠重建His角预防贲门癌术后返流30例临床分析 [J]. 陕西医学杂志, 2002, 10(3): 195196.
24. 李国珍, 郭燕玲, 孙培军. 机械加手法防止食管胃吻合口并发症 [J]. 肿瘤防治研究, 2005, 32(2): 127.
25. 林永海. 食管胃浆肌层瓣套入式吻合术治疗贲门癌84例分析 [J]. 中国实用医药, 2008, 3(8): 8485.
26. 施新民, 高俊, 樊天友, 等. 食管癌术后吻合口狭窄的预防 [J]. 现代肿瘤医学, 2005, 13(1): 6869.
27. 洪瑞, 方伟群, 李锐凯, 等. 食管贲门癌切除肠内器械吻合1 201例临床观察 [J]. 河北医药, 2010, 32(12): 15591560.
28. 邵令芳, 王其彰. 新编食管外科学 [M]. 第2版. 石家庄: 河北科学出版社, 2002: 513520.
29. 张勇, 高平, 王胜. 食管、贲门癌切除机械吻合术后反流性食管炎的临床研究 [J]. 宁夏医学杂志, 2009, 31(1): 5152.
30. 魏俊飞. 食管癌术后胃食管反流的临床研究 [J]. 中国民康医学(上半月), 2007, 19(10): 848849.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Antireflux Effects of Different Reinforcement Procedure in Mechanical Anastomosis for Esophageal and Cardiac Carcinoma

Abstract Full text Figures/Tables Video References Cited by

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