食管癌、贲门癌手术前后食管运动功能研究
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摘要
食管癌、贲门癌是我国常见的消化道恶性肿瘤。随着外科治疗水平不断提高，术后5年生存率已高达90％。外科常用食管胃吻合术治疗食管和贲门癌。由于术后半数以上患者出现反流性食管炎，严重影响术后患者的生存质量。由于缺少手术前后食管运动功能的研究，不能准确评价食管胃吻合术的抗反流效果。“隧道式”食管胃吻合术的特点是吻合口和食管末端被包绕在胃壁浆肌层和粘膜下层之间的隧道中。经长期临床应用，具有明显的防止吻合口瘘的作用。实验证明“隧道式”食管胃吻合术具有抗反流作用。但尚未进行术后食管运动功能
Carcinoma of the esophegus and cardia of the stomach are the most common malignant disease of the G-I tract in China. The Preferable treatment up to date is surgical resection and esophagogas trostomy. Unfortunately the postoperative quality of life in nearly one half of the patieats is more or less unsatisfied due to the presence of reflux esophagitis that occured in most cases following the convenfional end-to-side anastomosis. The thoracic surgeons are trying to improvethe technique for the purpose of preventing the nasty postoperative reflux though a final assessment is still in wanting because of lacking of extens-
Carcinoma of the esophegus and cardia of the stomach are the most common malignant disease of the G-I tract in China. The Preferable treatment up to date is surgical resection and esophagogas trostomy. Unfortunately the postoperative quality of life in nearly one half of the patieats is more or less unsatisfied due to the presence of reflux esophagitis that occured in most cases following the convenfional end-to-side anastomosis. The thoracic surgeons are trying to improvethe technique for the purpose of preventing the nasty postoperative reflux though a final assessment is still in wanting because of lacking of extens-
引文
1、Wu Y.K. et al:Progress in the study and surg-ical treatment of cancer of the esophagus in China. J. Thorac Cardiovasc Surg 1982; 84:325—333
2、邵令方等；食管癌和贲门癌6123例外科治疗结果分析中华外科杂志 1987；25：452—455
3、邵令方等：210例早期食管癌和贲门癌的外科治疗中华外科杂志 1981；19：259—261
4、阎昱，王连生；贲门癌外科治疗近况中国肿瘤临床 1986；3；103
5、王其彰等：食管癌切除后胃重建食管的测压观察中华外科杂志 1988；26(5)：305—307
6、吴昌荣等：贲门切除后食管残胃间带蒂空肠插入术预防返流性食管炎 中华胸心血管外科杂志 1989；5(2)：98—99(121)
7、 Earlam R: Clinical tests of oesophageal function London:Crosby Lodewood staples 1975.PP56
8、 Dodds WJ. et al: Instrumentation and methods of intra-tuminal esophageal manometry Arch. Inter. Med. 1976;136:515
9、 FyKe FE., Code CF., et al:The gastroesophageal junct- ion in healthy human beings Gastroenterologia(Basle) 1956;86:135
10、Pope CE., et al:Effect of infusion on force of closure measurements in the human esophagus Gastroenterology 1970;58:616
11、Cohen S., et al:Lower esophageal sphincter dysfunction in achalasia Gastroenterology 1971;61:814
12、Duranceau AC., et al:Esorhageal motility in asymptomatic volunteers Surg. Clin. N. AM. 1983;63:777
13、Richter JE., et al: Esophageal manometry in a healthy adult volunteers:Variability of pressures with age and frequency of"abnormal" contractions Dig. Dis. Sci. 1987;32:583
14、 Linehan JH., et al:Sleeve device function Startingresistor to record sphincter pressure Am. J. Physiol. 1985;248:G251—G255
15、王其章等：用腔内换能器进行下食管括约肌压力的测定河北医学院学报 1986；7：24
16、 Hurwitz AL.. et al:Disorders of esophageal motility WB. Sauders, Philadelphia 1979;PP14
17、Henderson RD.: Esophageal manometry inclinical investigation New YorK. Praeger 1983;PP49
19、 Winans CS . : Manometric asymmetry of thelower esophageal high pressure zone Am. J. Dig. Dis. 1977;22:348
20、Kaye MD., et al:Manometry configurationof the lower esophageal sphincter in normal human subjects Gastroenterology 1971;61:213
21、Kruse-Andersen S . , et al:Reflux patterns and related oesophageal moter activity in gastro-oesophagealref1ux disease. Gut 1990;31:633
22、Hendrix TR. Functions of the gastroesophageal segment. Clin. Gastroenterol. 1976 15:155
23、Hill LD.: Progress in the surgical management of h iatal hernia World J. Surg. 1977;1:425
24、DeMeester TR., et al:Evaluation of current operations for the prevention of gastroesophageal reflux. Ann. Surg. 1974;180:511
25、Johnson LE. , et al: Twenty-four-hour pH monitoring of the distal esophagus:A quantitative measureof gastroeso phageal reflux AM. J. Gastroenterol. 1974;62:325
26、 Ask P., et al:0n the use of monocrystalline antimony pH electrodes in gastro-oesophageal functional disorders. Medical and Biological Engineering Computing 1982;20:383
27、Staler E.J., et al: A Portable radiotelemetry receiver for ambulatory monitoring Journal of Biomedical Engineering 1982;4:247
28、Branicki FJ . , et al:Ambu latory monitoring of oesoph-ageal pH in reflux oesophagitis using a portable radiotelemetry system.Gut 1982;23:992
29、Willin L., et al:12-hour simultaneous registration of acid reflux and peristaltic activity in the oesophagus:A study in normol subjects of Scandinavian J. Gaslroenterol. 1979;14:561
30、Smout AJ . PM . , et al: Physiological gastroes ophagealrefhux and esophageal motor activity studied with a new system for 24-hour recording and automatic analysis Dig. Dis. Sci. 1989;34:372
31、Murphy DW., et al:Does the intraesophageal pH probeaccurately detect acid reflux? Simultaneous recording withtwo pH probes in humans.Dig. Dis. Sci. 1989;34:649
32、Si nnhuber: Beitrage zur lehre vom muscularen Cardiarerschluss.Zeitschrift fur klinische Medizin 1903;1:102-119
33、Helvetius:Observations anatomiques surl'estomac del'homme avec des reflexions sur le systeme comme la cause dela digestion des aliments Histoire de l'Academic Royal des sciences 1719;32:336
34、Lieberman M.D., et al:Muscular equivalert of the lower esophageal sphincter Gastroenterotogy 1979;76:31
35、Sancheg G. C., et al:Motor mechanisms of esophagus particularly of its distal portion Gastroenterotogy 1953;25:231
36、Jose B.: The role of the esophageal sphincter in reflux prevention J.Clin .Gastroenterol.1986;8(suppl): 2
37、DeMeester TR. et al:Clinical and in vitro analysis of determinants of antirefeux surgery Am. J. Sury. 1979;137:37
38、Luigi B., et al:Length of the distal esophageal sphincter and competency of the cardia Am. J. Sury. 1986;151:25
39、Lendrum FC.: Anatomic features of the cardiac orifice of the stomach with special reference tocardiospasm Arch. Intern. Med. 1937;59:474
40、Gastall DO.: Lower esophageal sphincter physiologic and clinical aspects Ann. Intern. Med. 1975;26:373
41、Willis T 《Pharmacentice Rationalis》1674 oxford
42、Bohnius DI.: 《Cireulus Anatomico-physiologicus》1710.PP126. Lipsiae
43、Jackson C.: The diaphragmatic pinchcockin so called cardiospasm Laryngoscope 1922;32:139
44、Altschuler SM. , et al: Simultaneous reflux inhibition of lower esophageal sphincter and crural diaphragm in cats Am. J. Physiol. 1985;249:G 586
45、Magendie F. 《A Summary of physiology》 1822 Translated form the French by John Rever Baltim-or Coale .
46、Creamer B. Oesophageal reflux Lancent 1955;1:279
47、Barret NR.: Hiatus hernia-a review of some contrave-rsial points Br. J. Surg. 1954;42:231
48、Mauta J.: The closing mechanism between the esophag-us and stomach Gastroenterotogia 1956;86:219
49、Negus VE. The mechanism of swallowing J. laryngol. Otol. 1943;58:46
50、Adler RH. et al:A valve mechanism to prevent gastro-esophageal reflux and esophagitis surgery 1958;44:63
51、Nissen R.: Gastropexy and " fundoplication" in surgical treatment of hiatal hernia Am. J. Dig. Dis. 1961;6:954
52、Donahue PE., et al:The floppy Nissen fundoplication effective long term control of pathologic reflux Arch. Surg. 1985;120:663
53、Henderson. RD., et al:Total fundoplication gastroplasty ( Nissen gastroplasty) :Five years review Ann. Thorac. Surg. 1985;39:74
54、Behar J., et al:Effect of anterior fundoplicaton on lower esophageal sphincter competence Gastroenterology 1974;67:209
55、Thal A. P. :A unified approach to surgical problemsof the gastroesophageal junction Ann. Surg. 1968;168:542
56、 Rossetti M., et al: Fundoplication for the treatment of gastroesophageal reflux in hiatal hernia World J. Surg. 1977;1:439
57、Angelchik JP., et al:A new surgical procedure for the treatment of gastroesophageal reflux and hiatal hernia S. G. O. 1979;148:246
58、Weaver RM; et al:Angelchik antireflux prosthesis:Post-operative clinical and objective assessmentat 12 months Gut 1984;25:A554
59、Kozarek RA., et al:Evaluation of Angelchik antirefl-ux prosthesis :long term results Dig. Dis. Sci. 1985;30:723
60、Wale RF . , et al:Pospective study of the antireflux prosthesis Br. J. Surg. 1985;72:520
61、 Durans D.:et al:The Angelchik antireflux prosthes-is:Some reservation Br. J. Surg. 1985;72:57
62、Wyllie J. H., et al: A quantitative assessment of results with the Angelchik prosthesis Ann. R. Coll. Surg. 1985;67:216
63、Skinner D. B., et al:Surgical managmentof esophage-al reflux and hiatus hernia: Long-term results with 1030 pa-tient J. Thorac. Cardioras. Surg. 1957;53:33
64、Belsey R.:Mark Ⅳ repair of hiatal hernia by the tr-ansthoracic approach World J. Surg. 1977;1:475
65、 Varisant JH., et al:Complications of vagatomy in the treatment of hiatal hernia Ann. Surg. 1976;183:629
66、 Washer G. F., et al:Randomised prospective trial of Roux-en-Y duodenal diversion versusfundoplic ation for severe reflux esophagitis Br. J. Surg. 1984;71:181
67、Gear M. W. L., et al:Randomised prospective trial of the Angelchik antireflux prosthesis Br. J. Surg. 1984;71:681
68、 Gouillat C., et al:Results of electiveNissen fundo- plication for gastroesophageal reflux in selected patients Dig. Surg. 1960;5:84
69、刘锟等：“隧道式”食管胃吻合术中华外科杂志 1983；8：458
70、 Rattan S., et al:Meural contral of the lower esophageal sphincter motitity in the cat. J. Physiol. 1979;273:647
71、Rattan S., et al:The mechanism of action of gastrinon the lower esophageal sphincter Gastroenterology 1976;70:828
72、Holloway pH. et al,Motilin:A mechanismin corperatingthe opossum lower esophageal sphincter into migrating motor complex Gastroenterology 1985;89:507
73、Reynolds JC., et al:a lower esophageal sphincter relax involving substance P.Am. J. Physiol. 1984;246:346
74、 Fisher R., et al: Mechanism of cholecystokinin induced inhibition of lower esophagealsphincter Gastroenterology 1977;73:57
75、范维珂，消化系统的病理生理学 见魏文汉主编《病理生理学》下册第一版上海科技出版社 1984
76、王云杰等：食管癌、贲门癌患者食管运动功能的研究(待发表) 1990
77、秦亚东等：食管贲门癌术后胃重建食管的测压研究全军第六届胸出外科专业学术会议论文与摘要汇编 1990 P130
78、王其彰等：食管癌切除术后返流性食管炎第二届全国食管癌学术会议交流材料 1986 P10
79、Harris LD et al:The pressure inversionpoint: its genesis and reliability Gastroenterology 1966;51:641
80、蔡振杰等：“隧道式”食管胃吻合术抗返流效果的初步探讨 第四军医大学学报 1983；4：115
81、范菂等；“隧道式”食管胃吻合术后吻合口愈合过程的实验观察 中华外科杂志 1990；28：378
82、 Bernstein L. M., et al:A clinical testfor esophagitis Gastroenterology 1958;34:760
83、 Tuttle S. G., et al:Detection of gastroesophageal reflux by simultaneous measurement of intruluminal pressure and pH. Proceding of the Society for Experimental Biololgy and Medicine 1958;98:225
84、 Kantrowitz P. A.. et al:Measurement of gastroesophagealreflux Gastroenterology 1969;56:666
85、Booth DJ., et al:Acid clearing from thedistal esophagus Arch. Surg. 1968;96:731
2、邵令方等；食管癌和贲门癌6123例外科治疗结果分析中华外科杂志 1987；25：452—455
3、邵令方等：210例早期食管癌和贲门癌的外科治疗中华外科杂志 1981；19：259—261
4、阎昱，王连生；贲门癌外科治疗近况中国肿瘤临床 1986；3；103
5、王其彰等：食管癌切除后胃重建食管的测压观察中华外科杂志 1988；26(5)：305—307
6、吴昌荣等：贲门切除后食管残胃间带蒂空肠插入术预防返流性食管炎 中华胸心血管外科杂志 1989；5(2)：98—99(121)
7、 Earlam R: Clinical tests of oesophageal function London:Crosby Lodewood staples 1975.PP56
8、 Dodds WJ. et al: Instrumentation and methods of intra-tuminal esophageal manometry Arch. Inter. Med. 1976;136:515
9、 FyKe FE., Code CF., et al:The gastroesophageal junct- ion in healthy human beings Gastroenterologia(Basle) 1956;86:135
10、Pope CE., et al:Effect of infusion on force of closure measurements in the human esophagus Gastroenterology 1970;58:616
11、Cohen S., et al:Lower esophageal sphincter dysfunction in achalasia Gastroenterology 1971;61:814
12、Duranceau AC., et al:Esorhageal motility in asymptomatic volunteers Surg. Clin. N. AM. 1983;63:777
13、Richter JE., et al: Esophageal manometry in a healthy adult volunteers:Variability of pressures with age and frequency of"abnormal" contractions Dig. Dis. Sci. 1987;32:583
14、 Linehan JH., et al:Sleeve device function Startingresistor to record sphincter pressure Am. J. Physiol. 1985;248:G251—G255
15、王其章等：用腔内换能器进行下食管括约肌压力的测定河北医学院学报 1986；7：24
16、 Hurwitz AL.. et al:Disorders of esophageal motility WB. Sauders, Philadelphia 1979;PP14
17、Henderson RD.: Esophageal manometry inclinical investigation New YorK. Praeger 1983;PP49
19、 Winans CS . : Manometric asymmetry of thelower esophageal high pressure zone Am. J. Dig. Dis. 1977;22:348
20、Kaye MD., et al:Manometry configurationof the lower esophageal sphincter in normal human subjects Gastroenterology 1971;61:213
21、Kruse-Andersen S . , et al:Reflux patterns and related oesophageal moter activity in gastro-oesophagealref1ux disease. Gut 1990;31:633
22、Hendrix TR. Functions of the gastroesophageal segment. Clin. Gastroenterol. 1976 15:155
23、Hill LD.: Progress in the surgical management of h iatal hernia World J. Surg. 1977;1:425
24、DeMeester TR., et al:Evaluation of current operations for the prevention of gastroesophageal reflux. Ann. Surg. 1974;180:511
25、Johnson LE. , et al: Twenty-four-hour pH monitoring of the distal esophagus:A quantitative measureof gastroeso phageal reflux AM. J. Gastroenterol. 1974;62:325
26、 Ask P., et al:0n the use of monocrystalline antimony pH electrodes in gastro-oesophageal functional disorders. Medical and Biological Engineering Computing 1982;20:383
27、Staler E.J., et al: A Portable radiotelemetry receiver for ambulatory monitoring Journal of Biomedical Engineering 1982;4:247
28、Branicki FJ . , et al:Ambu latory monitoring of oesoph-ageal pH in reflux oesophagitis using a portable radiotelemetry system.Gut 1982;23:992
29、Willin L., et al:12-hour simultaneous registration of acid reflux and peristaltic activity in the oesophagus:A study in normol subjects of Scandinavian J. Gaslroenterol. 1979;14:561
30、Smout AJ . PM . , et al: Physiological gastroes ophagealrefhux and esophageal motor activity studied with a new system for 24-hour recording and automatic analysis Dig. Dis. Sci. 1989;34:372
31、Murphy DW., et al:Does the intraesophageal pH probeaccurately detect acid reflux? Simultaneous recording withtwo pH probes in humans.Dig. Dis. Sci. 1989;34:649
32、Si nnhuber: Beitrage zur lehre vom muscularen Cardiarerschluss.Zeitschrift fur klinische Medizin 1903;1:102-119
33、Helvetius:Observations anatomiques surl'estomac del'homme avec des reflexions sur le systeme comme la cause dela digestion des aliments Histoire de l'Academic Royal des sciences 1719;32:336
34、Lieberman M.D., et al:Muscular equivalert of the lower esophageal sphincter Gastroenterotogy 1979;76:31
35、Sancheg G. C., et al:Motor mechanisms of esophagus particularly of its distal portion Gastroenterotogy 1953;25:231
36、Jose B.: The role of the esophageal sphincter in reflux prevention J.Clin .Gastroenterol.1986;8(suppl): 2
37、DeMeester TR. et al:Clinical and in vitro analysis of determinants of antirefeux surgery Am. J. Sury. 1979;137:37
38、Luigi B., et al:Length of the distal esophageal sphincter and competency of the cardia Am. J. Sury. 1986;151:25
39、Lendrum FC.: Anatomic features of the cardiac orifice of the stomach with special reference tocardiospasm Arch. Intern. Med. 1937;59:474
40、Gastall DO.: Lower esophageal sphincter physiologic and clinical aspects Ann. Intern. Med. 1975;26:373
41、Willis T 《Pharmacentice Rationalis》1674 oxford
42、Bohnius DI.: 《Cireulus Anatomico-physiologicus》1710.PP126. Lipsiae
43、Jackson C.: The diaphragmatic pinchcockin so called cardiospasm Laryngoscope 1922;32:139
44、Altschuler SM. , et al: Simultaneous reflux inhibition of lower esophageal sphincter and crural diaphragm in cats Am. J. Physiol. 1985;249:G 586
45、Magendie F. 《A Summary of physiology》 1822 Translated form the French by John Rever Baltim-or Coale .
46、Creamer B. Oesophageal reflux Lancent 1955;1:279
47、Barret NR.: Hiatus hernia-a review of some contrave-rsial points Br. J. Surg. 1954;42:231
48、Mauta J.: The closing mechanism between the esophag-us and stomach Gastroenterotogia 1956;86:219
49、Negus VE. The mechanism of swallowing J. laryngol. Otol. 1943;58:46
50、Adler RH. et al:A valve mechanism to prevent gastro-esophageal reflux and esophagitis surgery 1958;44:63
51、Nissen R.: Gastropexy and " fundoplication" in surgical treatment of hiatal hernia Am. J. Dig. Dis. 1961;6:954
52、Donahue PE., et al:The floppy Nissen fundoplication effective long term control of pathologic reflux Arch. Surg. 1985;120:663
53、Henderson. RD., et al:Total fundoplication gastroplasty ( Nissen gastroplasty) :Five years review Ann. Thorac. Surg. 1985;39:74
54、Behar J., et al:Effect of anterior fundoplicaton on lower esophageal sphincter competence Gastroenterology 1974;67:209
55、Thal A. P. :A unified approach to surgical problemsof the gastroesophageal junction Ann. Surg. 1968;168:542
56、 Rossetti M., et al: Fundoplication for the treatment of gastroesophageal reflux in hiatal hernia World J. Surg. 1977;1:439
57、Angelchik JP., et al:A new surgical procedure for the treatment of gastroesophageal reflux and hiatal hernia S. G. O. 1979;148:246
58、Weaver RM; et al:Angelchik antireflux prosthesis:Post-operative clinical and objective assessmentat 12 months Gut 1984;25:A554
59、Kozarek RA., et al:Evaluation of Angelchik antirefl-ux prosthesis :long term results Dig. Dis. Sci. 1985;30:723
60、Wale RF . , et al:Pospective study of the antireflux prosthesis Br. J. Surg. 1985;72:520
61、 Durans D.:et al:The Angelchik antireflux prosthes-is:Some reservation Br. J. Surg. 1985;72:57
62、Wyllie J. H., et al: A quantitative assessment of results with the Angelchik prosthesis Ann. R. Coll. Surg. 1985;67:216
63、Skinner D. B., et al:Surgical managmentof esophage-al reflux and hiatus hernia: Long-term results with 1030 pa-tient J. Thorac. Cardioras. Surg. 1957;53:33
64、Belsey R.:Mark Ⅳ repair of hiatal hernia by the tr-ansthoracic approach World J. Surg. 1977;1:475
65、 Varisant JH., et al:Complications of vagatomy in the treatment of hiatal hernia Ann. Surg. 1976;183:629
66、 Washer G. F., et al:Randomised prospective trial of Roux-en-Y duodenal diversion versusfundoplic ation for severe reflux esophagitis Br. J. Surg. 1984;71:181
67、Gear M. W. L., et al:Randomised prospective trial of the Angelchik antireflux prosthesis Br. J. Surg. 1984;71:681
68、 Gouillat C., et al:Results of electiveNissen fundo- plication for gastroesophageal reflux in selected patients Dig. Surg. 1960;5:84
69、刘锟等：“隧道式”食管胃吻合术中华外科杂志 1983；8：458
70、 Rattan S., et al:Meural contral of the lower esophageal sphincter motitity in the cat. J. Physiol. 1979;273:647
71、Rattan S., et al:The mechanism of action of gastrinon the lower esophageal sphincter Gastroenterology 1976;70:828
72、Holloway pH. et al,Motilin:A mechanismin corperatingthe opossum lower esophageal sphincter into migrating motor complex Gastroenterology 1985;89:507
73、Reynolds JC., et al:a lower esophageal sphincter relax involving substance P.Am. J. Physiol. 1984;246:346
74、 Fisher R., et al: Mechanism of cholecystokinin induced inhibition of lower esophagealsphincter Gastroenterology 1977;73:57
75、范维珂，消化系统的病理生理学 见魏文汉主编《病理生理学》下册第一版上海科技出版社 1984
76、王云杰等：食管癌、贲门癌患者食管运动功能的研究(待发表) 1990
77、秦亚东等：食管贲门癌术后胃重建食管的测压研究全军第六届胸出外科专业学术会议论文与摘要汇编 1990 P130
78、王其彰等：食管癌切除术后返流性食管炎第二届全国食管癌学术会议交流材料 1986 P10
79、Harris LD et al:The pressure inversionpoint: its genesis and reliability Gastroenterology 1966;51:641
80、蔡振杰等：“隧道式”食管胃吻合术抗返流效果的初步探讨 第四军医大学学报 1983；4：115
81、范菂等；“隧道式”食管胃吻合术后吻合口愈合过程的实验观察 中华外科杂志 1990；28：378
82、 Bernstein L. M., et al:A clinical testfor esophagitis Gastroenterology 1958;34:760
83、 Tuttle S. G., et al:Detection of gastroesophageal reflux by simultaneous measurement of intruluminal pressure and pH. Proceding of the Society for Experimental Biololgy and Medicine 1958;98:225
84、 Kantrowitz P. A.. et al:Measurement of gastroesophagealreflux Gastroenterology 1969;56:666
85、Booth DJ., et al:Acid clearing from thedistal esophagus Arch. Surg. 1968;96:731