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目的探讨食管贲门癌术后胸胃排空障碍的成因和预防措施。方法食管贲门癌手术１５４７例，发生胸胃排空障碍１５例，均为上腹、右胸、左颈吻合。手术方式由术中将食膈孔扩张至４指使胃通过时充分舒张，改为行食膈孔处切断部分膈肌。结果行食膈孔处切断部分膈肌，术后未发生胸胃排空障碍。结论胸胃排空障碍与迷走神经切断致胃解剖位置变化而影响胃十二指肠压力梯度和胃窦部功能及胃泌素分泌的功能有关，也与常规扩张食膈孔后膈肌自行回缩、膈肌重建过紧、胸胃远端呈“Ｓ”型扭曲、幽门位于膈肌以上使十二指肠呈关闭状、胃扭曲和术后粘连等机械性因素有关。
Objective To investigate the causes of thoracic gastric emptying after esophageal and cardiac cancer surgery and their preventive measures. Methods There were 1547 cases of esophageal and cardiac cancer surgery. There were 15 cases of thoracic gastric emptying, which were all anastomosis of the upper abdomen, right chest and left neck. The operation method was to dilate the hole of the chyme from the operative cavity to 4 fingers to fully relax the stomach, and to cut off part of the diaphragm muscle at the hole of the chyme. Results Some diaphragms were cut at the hole of the chyme and no postoperative thoracic and gastric emptying was observed. Conclusions The thoracic gastric emptying dysfunction and the change of gastric anatomy caused by vagotomy are related to the function of gastroduodenal pressure gradient and the function of gastric antrum function and gastrin secretion. It is also related to the self-retraction of diaphragm after conventional dilation of sacral foramen. Diaphragmatic muscle remodeling too tight, “S”-shaped distortion of the distal chest and stomach, pylorus is located above the diaphragm to close the duodenum, gastric distortion and postoperative adhesions and other mechanical factors.