胸段食管癌切除术中保留迷走神经干的可行性探讨

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作者对47例胸段食管癌手术中保留迷走神经干行分组对比研究,其中保留神经组20例,常规手术对照组27例。保留组18例和对照组26例行根治性手术;余为姑息性手术。病理学检查发现保留组3例(15.0%)和对照组3例(11.1%)癌已浸润近迷走神经干或/和其分支附近;另外,保留组1例(5.0%)和对照组3例(11.1%),癌已侵及神经。基础胃酸分泌量(BAO)及胃排空时间(T1/2)测定:保留组BAO均数值(1.93mmol/h)和T1/2均数值(63.51分)与对照组BAO(0.75mmol/h)和T1/2(>105分)之间的差别皆显著;而与正常人组和术前对照组相比则差异无显著性意义。作者认为,术中保留迷走神经是可行的,术后胃的泌酸及运动功能损伤轻。但手术指征应限于T1~T2等较早期的病变,否则会影响手术的根治性。 The authors grouped contrast-retained vagal nerve trunks in 47 cases of thoracic esophageal carcinoma during surgery, including 20 cases of nerve preservation group and 27 cases of conventional surgical control group. 18 patients in the retention group and 26 in the control group underwent radical surgery; the remainder were palliative. Pathological examination revealed that 3 patients (15.0%) in the retained group and 3 (11.1%) in the control group had cancer infiltrated near the vagus nerve trunk and/or its branches; in addition, 1 patient (5.0%) in the retained group. And in the control group, 3 patients (11.1%) had invaded the nerves. The basal gastric acid secretion (BAO) and gastric emptying time (T1/2) were determined: the mean BAO values ​​(1.93 mmol/h) and the mean T1/2 values ​​(63.51 points) in the reserved group and the control group BAO (0. The difference between 75mmol/h) and T1/2 (>105 points) was significant; while there was no significant difference between the normal group and the preoperative control group. The authors believe that it is feasible to retain the vagus nerve during the operation, and that the postoperative gastric acid and motor function are lightly damaged. However, surgical indications should be limited to earlier lesions such as T1 ~ T2, otherwise it will affect the radical surgery.
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