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相關文獻
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頁籤選單縮合
題名 | Reflux Esophagitis after Proximal Subtotal Gastrectomy=近端次全胃切除引起之逆流性食道炎 |
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作者 | 王仲陽; 許宏道; 張晃宙; 黃睦舜; 管毅剛; 蘇建銘; | 書刊名 | 中華醫學雜誌 |
卷期 | 59:6 1997.06[民86.06] |
頁次 | 頁348-353 |
分類號 | 416.24 |
關鍵詞 | 尼森氏胃底摺疊術; 近端次全胃切除; 逆流性食道炎; Floppy Nissen fundoplication; Proximal subtotal gastrectomy; Refluxesophagitis; |
語文 | 英文(English) |
中文摘要 | 背景:近端次全胃切除主要用於治療賁門癌之患者。手術著眼於惡性貧血之避免,並期保留較佳之功能,及更好之生活品質。臨床之觀察出乎我們所預期之結果。次全胃切除引起之逆流性食道炎造成患者相當大之困擾及痛苦。是故本研究之目的,在以客觀的方法證明術後確實存在嚴重之逆流性食道炎。 方法:二十位患者都曾接受過近端次全胃切除。術中我們以尼森氏抗逆流胃底摺疊術避免胃食道逆流。術後我們對此二十位患者加以追蹤,並行食道蠕動檢查。統計下段食道胃交接處高壓帶之壓力及長度、二十四小時食道酸鹼測定、食道鏡檢,並記錄其臨床之症狀加以比較及分析。 結果:絕大多數之患者皆有逆流性食道炎之症狀。80%之患者於鏡檢下有食道炎之表現。食道胃交接之高壓帶平均壓力為8.03 +/- 7.01 mmHg,總長度為1.60 +/- 0.56 cm,腹內長度為1.29 +/- 0.30 cm,二十四小時食道酸鹼測定值為85.8 +/- 45.6。 結論:我們認為近端次全胃切除不若預期之理想。嚴重之胃食道逆流確實存在。手術在一方面要確保切除之安全距離,一方面要完全之抗逆流手術中,胃食道逆流是一難以克服之問題。次全胃切除需要重新檢討其手術方法。是故,在早期賁門癌之治療,全胃切除仍是主流之手術方法。 |
英文摘要 | Background: Carcinoma of the cardia of stomach or carcinoma of the esophagocardiac (EC) junction has a poor prognosis. Proximal subtotal gastrectomy is often performed for a smaller tumor. It achieves a prognosis similar to that of total gastrectomy and prevents pernicious anemia. A better functional result was expected than that total gastrectomy did from us, but the clinical observation was surprising. Most patients had symptoms of reflux esophagitis after surgery. All of these patients were re-evaluated. Methods: From November, 1990 to March, 1995, there were 27 patients who received proximal subtotal gastrectomy at this hospital. Twenty of these were involved in this study. Floppy Nissen's fundoplication was performed during operation as a anti-reflux procedure. Continuous 24-h pH monitoring, esophageal manometry, and endoscopic examination were performed for study. Results: Most of the patients had symptoms of gastroesophageal reflux. 80% (16/20) of the patients were found to have reflux esophagitis under endoscopy. The patients had higher pH scores (mean 85.8 +/- 45.6) than normal (< 17.5), lower pressure of LES (8.03 +/- 7.01 mmHg), shorter total lengths (mean 1.60 +/- 0.56 cm) and intrabdominal lengths (mean 1.29 +/- 0.30 cm) of new lower esophageal sphincters. Conclusions: Clearly there was failure to prevent reflux esophagitis through floppy Nissen's fundoplication. Severe gastroesophageal reflux did appear after proximal gastric resection. A gastric remnant with safe cut-margin is often too short to perform complete wrapping. Proximal subtotal gastrectomy is not recommended for early cancer of the cardia of the stomach. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。