食管癌术后胸腔胃功能的研究

发布时间：2018-03-31 21:48

本文选题：食管癌　切入点：胃动素　出处：《河北医科大学》2015年硕士论文

【摘要】：目的:研究食管癌术后胸腔胃的功能。食管癌是常见的恶性肿瘤之一,外科手术治疗已经成为其首选的治疗方式。按照国际抗癌联盟(union for international cancer control UICC)食管癌的分段标准,食管癌可分为食管胸上段癌,距离门齿20-25cm;食管胸中段癌,距离门齿25-30cm;食管胸下段癌,距门齿30-40cm。但是,无论肿瘤处于食管胸上段、胸中段还是胸下段,外科手术治疗时,不仅切除食管大部、食管胃结合部甚至切除近端胃,而且切断支配胃的神经,胃的全部或大部由正压的腹腔转移至负压的胸腔,不可避免的破坏固有的解剖结构,导致残留食管、胸胃的结构和功能的变化,如胃食管反流(gsatro-esophageal reflux GER)、吞咽顺应性降低、烧心等症状,严重影响患者术后生活质量。因此,了解食管癌术后患者胸腔胃功能,对于改善其术后症状、提高术后生活质量至关重要。但多数学者的资料来源于患者术后的主观叙述,本研究拟通过研究食管癌术后胸腔胃胃酸分泌的变化,并且对患者空腹血液中胃动素、胃泌素水平进行检测,以期了解食管癌术后胸腔胃胃酸分泌变化对胸腔胃消化功能的影响。方法:本实验选取省四院胸外科和深州市医院2008年9月-2009年9月期间,行食管癌根治术的患者35例,其中男性22例,女性13例,年龄45-72岁,平均年龄65.4岁。该35例患者符合入组条件,均属于鳞状细胞癌。另设15例无消化道病变住院患者做正常对照,其中男性9例,女性6例,平均年龄为64.5岁。将35例病人分为术前、术后1个月、3个月、6个月及12个月,共5组。以胃液量、基础胃酸分泌量(basal acid output BAO)、胃液p H值作为胸胃功能的指标,测定患者术前术后胃液量、基础胃酸分泌量及胃液p H值。同时对患者进行采血,应用放射免疫法测定受试者血浆中胃动素和血清中胃泌素含量。统计学方法:应用均数±标准差(x?s)表示,采用多元回归分析患者术前、术后胃液量、基础胃酸分泌量、胃液p H值变化。应用配对t检验(Paired Samples T test)分析食管癌术后1个月、3个月、6个月及12个月的术前、术后胃液p H值变化,同时将空腹血液的胃动素、胃泌素变化参数进行Spearman’s相关分析。数据采用Graph Pad Prism5.01软件进行分析,以点状图分布表示,一个点表示一个样本,采用配对t检验比较胃酸p H术前术后变化有无统计学意义,以P0.05为在统计学上有显著性差异,以P0.01为在统计学上有极显著性差异。结果:1胸胃泌酸功能变化1.1食管癌患者术后1个月胃液量及基础胃酸分泌量明显降低,与术前组患者相比,差异有统计学意义(P0.001)。术后3个月胃液及基础胃酸分泌量仍低于术前组,差异有统计学意义(P0.001)。术后6个月较术后3个月有所上升,但与术前组对比,差异有统计学意义(P0.05)。术后12个月与术前组相比,差异无统计学意义(P0.05),表明胃液量与基础胃酸分泌量在术后一年恢复至正常水平。1.2食管癌术后一月胃液p H值显著上升,与术前相比,有统计学意义(P0.001,P=0.00025)。术后3个月胃液p H值仍呈现上升趋势,高于术前对照组,差异有统计学意义(P0.001,P=0.00046)。术后6个月值较术后3个月有所下降,但仍高于术前组,差异有统计学意义(P0.001,P=0.00032)。胃液p H值术后1年上述指标恢复至术前对照组水平,差异无统计学意义(P0.05,P=0.065)。2血液胃动素、胃泌素测定结果2.1空腹血浆胃动素水平:正常对照组患者血浆胃动素含量在试剂盒说明书提供的参考值范围内,分析数值与试剂盒说明书所提供的参考值无显著差异(P0.05,P=0.074血浆胃动素正常参考值为253.16±68.24p)。术前对照组高于正常对照组(P0.001,P=0.00067)。患者术后1个月血浆胃动素水平明显高于术前对照组,具有统计学意义(P0.001,P=0.00058)。术后3个月,胃动素水平呈现下降趋势,但胃动素水平高于术前对照组,且具有统计学意义术(P0.001,P=0.00024)。术后6个月胃动素水平逐渐恢复至正常对照组水平,但仍高于正常对照组(P0.05,P=0.055)。术后1年患者血浆胃动素水平降至正常对照组水平,差异无统计学意义(P0.05,P=0.055)。2.2空腹血清胃泌素水平:正常对照组患者血清胃泌素浓度与说明书所提供的正常参考值无明显差别(P0.05,P=0.076,血清胃泌素正常参考值为20-160ng/L);术前对照组高于正常对照组(P0.05,P=0.042)。术后1个月血清胃泌素水平明显高于术前对照组,具有统计学意义(P0.001,P=0.00021)。术后3个月,胃泌素水平呈现下降趋势,但胃泌素水平高于正常对照组,且具有统计学意义术(P0.001,P=0.00036)。术后6个月血清胃泌素水平逐渐恢复至正常对照组(P0.05,P=0.041);术后1年,血清胃泌素水平降至术前对照组水平,差异无统计学意义(P0.05,P=0.068)。3胸腔胃液p H值变化与血液胃动素、胃泌素的相关性术后胸腔胃液量、基础胃酸分泌量与胃液p H值、血浆胃动素、血清胃泌素术后1个月水平呈负相关。胃液p H值的动态变化与血浆胃动素水平呈正相关,与血清胃泌素水平变化呈正性相关。结论:1食管癌患者术后1个月胃液量及基础胃酸分泌量明显降低,术后3个月开始上升,术后12个月基本恢复至术前水平。2食管癌患者术后1个月胃液p H值显著上升,术后6个月后开始下降,术后12个月恢复至术前水平。3食管癌患者术后1个月血浆胃动素含量明显上升,术后6个月开始下降,术后12个月恢复至术前水平。4食管癌患者术后1个月血清胃泌素含量明显上升,术后6个月开始下降,术后12个月恢复至术前水平。5食管癌患者术前与术后空腹血浆胃动素与血清胃泌素变化与胃液p H值的变化呈正相关。
[Abstract]:Objective : To study the function of thoracic stomach after operation of esophageal carcinoma . It is one of the most common malignant tumors . Surgical treatment has become the preferred treatment modality . The gastric juice content , gastric acid secretion and gastric juice p - H in the plasma of patients with esophageal cancer were analyzed by using the method of multiple regression analysis . The p - H value of gastric juice still increased in 3 months after operation , which was higher than that of the control group before operation ( P 0.001 , P = 0.0046 ) . The postoperative 6 - month value was lower than that in the preoperative group ( P = 0.001 , P = 0.000032 ) . There was no significant difference ( P0.05 , P = 0.065 ) . The levels of serum gastrin and gastrin in normal control group were not significantly different ( P0.05 , P = 0.074 , and the normal reference value was 253.16 卤 68.24p ) . The control group was higher than that of the control group ( P0.001 , P = 0.00067 ) . The plasma levels in plasma were significantly higher in 1 month after operation than in the control group ( P < 0.001 , P = 0.0058 ) . At 3 months after operation , the level of gastric activity decreased , but the level of gastric activity was higher than that of the control group before operation ( P 0.001 , P = 0.0024 ) . At 6 months after operation , the level of gastric activity gradually recovered to the normal control group , but it was still higher than that of the normal control group ( P0.05 , P = 0.055 ) . There was no significant difference between the serum gastrin concentration and the normal reference value ( P0.05 , P = 0.076 , the normal reference value of serum gastrin was 20 - 160 ng / L ) . The control group was higher than that of the normal control group ( P0.05 , P = 0.042 ) . The serum gastrin levels were significantly higher in 1 month after operation than in the control group ( P < 0.001 , P = 0.0021 ) . The gastrin levels showed a decrease in gastrin levels in 3 months after operation , but gastrin levels were higher than those in the normal control group and had statistical significance ( P 0.001 , P = 0.0036 ) . The serum gastrin levels in patients with esophageal carcinoma were significantly lower than those in normal control group ( P0.05 , P = 0.068 ) .

【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R735.1

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