The influence of tubular stomach and its position and width on gastroesophageal reflux after esophageal cancer surgery / 中国医师进修杂志

ABSTRACT

Objective:To investigate the effect of total gastric replacement of esophagus and tubular gastric replacement of esophagus on gastroesophageal reflux after esophageal cancer surgery, and the correlation between the anastomosis position and width of tubular stomach and gastroesophageal reflux.Methods:Eighty-eight patients with esophageal cancer admitted to Lu′an Hospital of Peking University Medical Group were retrospectively analyzed. According to the operation methods, they were divided into study group (tube stomach instead of esophagus anastomosis) and control group (whole stomach instead of esophagus anastomosis). The effects of two operation methods on gastroesophageal reflux were compared, and the effects of the position and width of tube stomach instead of esophagus anastomosis on the symptoms were analyzed.Results:Three months after operation, the frequency of acid reflux ≥ 5 minand 24 h acid reflux in the study group were less than those in the control group (2.5 ± 1.7) times vs. (6.2 ± 2.1) times, (17.3 ± 8.8) times vs. (31.5 ± 7.9) times; the total time of pH < 4 and the longest acid reflux time in the study group were shorter than those in the control group (85.3 ± 30.1) min vs. (118.2 ± 32.6) min, (22.4 ± 6.8) min vs. (31.8 ± 7.4) min; and the differences were statistically significant ( P<0.05). The reflux disease questionnaire score and the incidence of gastroesophageal reflux disease in the study group were lower than those in the control group (8.9 ± 4.6) scores vs. (13.8 ± 4.1) scores, 6.7%(3/45) vs. 23.3%(10/43), and the differences were statistically significant ( P<0.05). In the 4 subgroup of the study group, the incidence of reflux symptoms, pH<4 cumulative time and the number of reflux symptoms were the lowest in the cervical anastomosis+width<3 cm subgroup, and the histological inflammatory reaction grade of esophageal mucosa under endoscopy was the lightest in the study group, and the differences were statistically significant ( P<0.05). Conclusions:Compared with total gastric anastomosis, tube stomach instead of esophagus anastomosis can reduce the incidence of gastroesophageal reflux more effectively, and neck anastomosis+tube stomach width <3 cm and anastomosis method are the best for gastroesophageal reflux.