不同术式食管癌切除术患者术后胃肠减压量的对比研究

发布时间：2018-04-08 07:29

本文选题：食管癌　切入点：管状胃　出处：《河北医科大学》2017年硕士论文

【摘要】：目的:食管癌属于一种常见的恶性消化道肿瘤,其首选治疗是以手术为主的综合治疗。在食管癌患者的术后治疗中,胃肠减压扮演了重要的角色。胃肠减压能有效地引流出术后患者胃内的消化液及气体,降低胃肠道的腔内压力,使腹胀减弱,促进胃肠道功能的恢复,消化液的及时引出可以减少吻合口暴露于侵蚀性消化液中的机会,并可以减轻吻合口的张力,减少吻合口瘘的出现。同时术后持续的胃肠减压可以降低胃储留及胸胃综合征的发生率。本研究通过比较不同术式食管癌根治术患者术后胃肠减压量,探讨接受不同方式的胃代食管手术的患者术后胃液的生成及引流特点,以及影响胃肠减压量的因素。方法:1回顾性分析河北医科大学第四医院胸五科单中心自2015年01月至2016年3月行食管癌切除术的113例患者的病例资料,统计行不同术式的食管癌根治术患者术后前三天的胃肠减压量。2按照患者住院时所行的不同的手术方式分为管状胃组(经腹腔游离胃、经右侧胸腔游离食管、食管胃胸内吻合,和经右侧胸腔游离食管、经腹腔游离胃、食管胃颈部吻合)和非管状胃组(开左胸经膈肌食管胃弓上/弓下吻合)。管状胃组58例患者,男性39例,女性19例,年龄51-72岁,中位年龄63岁(63.05±4.52),其中19例患者所行手术方式为经腹腔游离胃,经右侧胸腔游离食管,食管胃胸内吻合;21例患者所行手术方式为经右侧胸腔游离食管,经腹腔游离胃,食管胃左颈部吻合术;18例患者所行手术方式为经右侧胸腔游离食管,经腹腔游离胃,食管胃右颈部吻合术。非管状胃组55例患者,男性42例,女性11例,年龄44-73岁,中位年龄63岁(63.14±6.43),其中10例患者所行手术方式为经左侧胸壁后外侧切口进入胸腔游离食管,打开膈肌游离胃,食管癌切除,食管胃弓下吻合术;45例患者所行手术方式为经左侧胸壁后外侧切口进入胸腔游离食管,打开膈肌游离胃,食管癌切除,食管胃弓上吻合术。3术后胃肠减压量的比较:所有手术患者均采用术中置入负压吸引胃肠减压管于胃腔内,术后均给予抑酸药物治疗且前三天胃肠道功能均未恢复,分别记录不同患者术后第一天、第二天及第三天的胃肠减压量,并计算总量,找出影响胃肠减压量的因素,并比较不同手术方式之间患者胃肠减压量的差别,探讨不同方式的胃代食管手术后胃液的生成及引流特点。4统计方法:对于收集的所有数据使用spss13.0统计软件进行分析,用均数±标准差(x±s)表示患者术后胃肠减压量,对于符合正态、方差的齐计量资料选用单因素anova方差分析;对于不符合正态、方差齐的计量资料选用两个独立样本比较的wilcoxon秩和检验;对于比较计数资料率的选用卡方检验;检验水准α=0.05,p0.05为差异具有统计学意义。结果:1管状胃组术后前三天平均胃肠减压量为54±50.85ml,而非管状胃组平均胃肠减压量为120±61.66ml(z=-5.215,p0.001)。管状胃组术后胃肠减压量小于非管状胃组。2管状胃组内行不同术式患者术后胃肠减压量具有统计学差异(x~2=6.400,p0.05)。非管状胃组内行不同术式患者术后胃肠减压量无统计学差异(z=5.742,p0.05)。3不同性别患者术后胃肠减压量的差异无统计学意义(z=-0.433,p=0.665)。不同年龄组患者术后胃肠减压量的差异无统计学意义(x~2=1.42,p=0.887)。是否有吸烟史对患者术后胃肠减压量的影响无统计学意义(z=-0.01,p=0.992)。是否有饮酒史对患者术后胃肠减压量的影响无统计学意义(z=-0.958,p=0.338)。术后不同时间患者的胃肠减压量的差异无统计学意义(z=-1.277,p=0.201)。不同吻合位置的患者术后胃肠减压量的差异具有统计学意义(z=-2.209,p=0.027)。结论:1使用管状胃代食管的术式(包括mckeowen颈部吻合术、ivorlewis术)可减少患者术后胃肠减压量及胃食管反流及胸胃综合征的发生率。2采用管状胃代食管的术式中,吻合口的位置越高,患者术后胃肠减压量反而越小。3食管癌切除术患者术后胃肠减压量与年龄、性别、有无吸烟饮酒史及术后时间无关。
[Abstract]:Objective : To study the effect of gastrointestinal decompression on postoperative gastric emptying in patients with esophageal carcinoma and to reduce the incidence of gastrointestinal decompression . The results showed that the mean gastrointestinal decompression volume was 54 卤 50.85 ml in the first three days after operation and 120 卤 61.66ml ( z = - 5.215 , p0.001 ) . The postoperative gastrointestinal decompression of tubular gastric group was less than that of non - tubular gastric group . There was significant difference in postoperative gastrointestinal decompression ( x ~ 2 = 6.400 , p < 0.05 ) . There was no statistical difference in postoperative gastrointestinal decompression ( z = 5.742 , p = 0.665 ) in patients with non - tubular gastrectomy ( z = 5.742 , p < 0.05 ) . There was no significant difference in postoperative gastrointestinal decompression between different age groups ( x ~ 2 = 1.42 , p = 0.887 ) . The effect of smoking history on postoperative gastrointestinal decompression was not statistically significant ( z = - 0.01 , p = 0.992 ) . There was no statistically significant effect of alcohol history on postoperative gastrointestinal decompression in patients ( z = - 0.958 , p = 0.338 ) . There was no significant difference in the amount of gastrointestinal decompression in patients with different time after surgery ( z = - 1.277 , p = 0.201 ) . The difference in postoperative gastrointestinal decompression between patients with different anastomotic sites was statistically significant ( z = - 2.209 , p = 0.027 ) . Conclusion : 1 The incidence of postoperative gastrointestinal decompression and gastroesophageal reflux and chest - gastric syndrome can be reduced by using tubular gastroesophageal reflux surgery ( including mckethoracic cervical anastomosis , ivorlewis technique ) . The higher the location of anastomotic stoma , the smaller the postoperative gastrointestinal decompression in patients with esophageal carcinoma . The postoperative gastrointestinal decompression is not related to age , sex , smoking and drinking history and postoperative time .

【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.1

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