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目的 食管癌切除术中保留迷走神经干及其肝支、腹腔支和鸦爪支 ,观察患者手术前后的消化功能变化。方法 将 4 0例食管癌 ( Tis～ 2 N0～ 1 M0 )患者随机分为迷走神经切断组和保留组 ,分别于手术前和手术后 3天、1月、1年 ,测定患者的胃液量、基础胃酸分泌量、胃液 p H值、空腹血清胃泌素、钡餐胃排空时间以及胆囊 B型超声波和胃内镜检查。结果 两组患者的胃液量、基础胃酸分泌量比较 ,术前和术后 3天、1月差异无显著性 ( P>0 .0 5 ) ,术后 1年差异有显著性 ( P<0 .0 1)。两组患者的胃酸 p H值、空腹血清胃泌素、胃排空时间这三项指标比较 ,术后 1月差异有显著性 ( P<0 .0 1) ,术后 1年差异无显著性 ( P>0 .0 5 )。随访 3年 ,两组患者术后胆囊收缩功能下降、贫血、萎缩性胃炎的发生率 ,保留组均低于切断组 ,但差异无显著性 ( P>0 .0 5 )。两组患者术后腹泻、胆囊结石的发生率 ,切断组高于保留组 ,差异有显著性 ( P<0 .0 5 )。结论 食管癌切除术保留迷走神经干及其肝支、腹腔支和鸦爪支 ,能够改善患者术后的消化功能 ,提高患者术后的生活质量
Objective To preserve the vagus nerve trunk, its liver branch, abdominal branch and crow’s claw in resection of esophageal cancer and observe the changes of digestive function before and after the operation. Methods Forty patients with esophageal cancer (Tis ~ 2 N0 ~ 1 M0) were randomly divided into vagotomy group and preservation group. The volume of gastric juice was measured before operation and 3 days, 1 month and 1 year after operation, respectively. Gastric acid secretion, gastric juice p H value, fasting serum gastrin, barium meal gastric emptying time and gallbladder type B ultrasound and endoscopy. Results There was no significant difference in gastric juice volume and basal gastric acid secretion between the two groups before and 3 days and 1 month after operation (P> 0.05). The difference was significant at 1 year after operation (P <0. 0 1). Two groups of patients with gastric acid p H value, fasting serum gastrin, gastric emptying time these three indicators, one month after the difference was significant (P <0.01), one year after the difference was not significant (P> 0.05). After 3 years of follow-up, the gallbladder contractile function decreased, the incidence of anemia and atrophic gastritis in both groups was lower than that in the sever group, but the difference was not significant (P> 0.05). The incidence of postoperative diarrhea and gallstones in the two groups was significantly higher than that in the reserved group (P <0.05). Conclusion Esophageal cancer resection preserves the vagus nerve trunk, its liver branch, abdominal branch and crow’s claw. It can improve the postoperative digestive function and improve the postoperative quality of life