| Multichannel intraluminal impedance technology was born in the late1980s, to monitor the flow of liquid and (or) gas in the gastrointestinal cavity, it is the most sensitive method to find and identify gastroesophageal reflux event. It has been announced that the24hrs mobile esophageal impedance-pH monitor the normal values in healthy volunteers by the United States and Europe, this technology is still in its infancy in the domestic application. The technology is not only able to identify pH>4reflux events that is neutralized by food or antacid treatment, but also reflect the bolus volume, composition and change of pH value in other parts of the esophagus. Esophageal impedance monitoring combine with pH monitoring can remedy the limitations of single pH monitoring. The different pH values that is monitored by the combination pH monitoring can also further classify the gastroesophageal reflux, and studies have proved it has a good repeatability. The technology has been applied in the assessment of the diagnosis and treatment of gastroesophageal reflux disease, but it is still lack of the relevant application research about postoperative gastrointestinal reflux.Cardia carcinoma is a common tumor in clinic, in the proximal gastrectomy, the traditional digestive tract reconstruction is to do the gastroesophageal anastomosis bow under the left breast. This surgical reconstruction of digestive tract is relatively simple, but it can cause postoperative gastrointestinal reflux. Jejunum interposition technique can effectively reduce the cardia postoperative gastrointestinal reflux. The first part of this paper will use the impedance-pH monitoring by comparing two different surgical methods, monitoring the reflux frequency, time, and acid-base properties of reflux content occurred in the post operation. To discuss the anti-impedance-pH monitoring applications in the postoperative cardia reflux.In the Esophageal resection, the stomach is the best alternative materials, to rebuild the upper digestive tract. There are still many complications using the stomach to rebuild gastric tube in the esophagectomy. The tubular gastric technology has been widely applied in the clinic, some studies suggest that it is effective to prevent thoracic stomach syndrome and reflux esophagitis happening. The second part of this article will be applied MII-pH technique to monitor the reflux in the postoperative tubular stomach and general stomach esophagectomy, to assess whether the tubular gastric technology have a preventive effect to the incidence of postoperative reflux.PartⅠ Significance of impedance-pH monitoring in the assessment of the cardia postoperative gastroesophageal refluxObjective:To assess the significance of monitoring impedance-pH to detect postoperative gastrointestinal reflux in the different cardia surgical methods.Methods:Divided20patients with cardiac adenocarcinoma into two groups,10cases in each of group, the group A, jejunal interposition technique, the group B with traditional through left proximal gastrectomy esophagogastric anastomosis type. All patients were followed at3months after surgery. All the patients do the24hrs MII-pH monitoring, monitor the single pH monitoring index and MII-pH monitoring index in24hours standing position and recumbent position. The former including:acid reflux episodes, acid reflux time, average acid clearing time, the number that reflux is more than5-minute, longest reflux time, Demeester score index. The latter include:the total number of reflux, acid reflux episodes (pH<4), non-acid reflux episodes (pH>4), acid reflux time, non-acid reflux time, the median bolus clearing time (back up to impedance starting value, and the duration is longer than5S) and longest reflux time.Results:The general information of the two groups has no statistically significant. Simply pH monitoring results indicate that statistically significant difference in the acid reflux episodes, acid reflux time, the average acid clearing time, reflux number of more than5minutes, the longest reflux time, Demeester score index, exists between A and B groups in the standing position and recumbent position, suggesting that the acid reflux in the postoperative jejunum set is significantly less than the control group. Impedance-pH monitoring results indicate that there is a significant difference between A and B group in acid reflux time, non-acid reflux time, acid reflux episodes, non-acid reflux episodes, the median bolus clear time and the longest reflux time.Conclusion:MII-pH technology, from acid reflux and non-acid reflux, can analyses comprehensively postoperative gastrointestinal reflux after cardia carcinoma; jejunal interposition surgery can reduce postoperative reflux episodes and improve the life quality.of patients after gastric cardia.Part Ⅱ The effect of Impedance-pH monitoring to detect and evaluate the effect of the tubular stomach surgery of esophageal cancer in resisting the postoperative gastroesophageal reflux.Objective:The effect of Impedance-pH monitoring to detect and evaluate the effect of the tubular stomach surgery of esophageal cancer in resisting the postoperative gastroesophageal reflux.Mothods:20patients with esophageal squamous cell carcinoma were divided into two groups, each group are10cases, the group C, the tubular stomach surgery technique, the group B, with traditional through right proximal gastrectomy esophagogastric anastomosis type. All patients were followed at3months after surgery. All the patients do the24hrs MⅡ-pH monitoring, monitor the single pH monitoring index and MⅡ-pH monitoring index in24hours standing position and recumbent position. The former including:acid reflux episodes, acid reflux time, average acid clearing time, the number that reflux is more than5-minute, longest reflux time, Demeester score index. The latter include:the total number of reflux, acid reflux episodes (pH<4), non-acid reflux episodes (pH>4), acid reflux time, non-acid reflux time, the median bolus clearing time (back up to impedance starting value, and the duration is longer than5S) and longest reflux time.Meanwhile, recording reflux symptoms, including the occurring time and of acid regurgitation, cough, nausea, heartburn and other symptoms, as well as the onset of symptoms recorded reflux events.Results:The general information of the two groups has no statistically significant. Simply pH monitoring results indicate that no statistically significant difference in acid reflux episodes, non-acid reflux, the average acid clearing time, reflux number of more than5minutes, the longest reflux time, Demeester score index, exists between C and D groups. Impedance-pH monitoring results indicate the same result. It is suggesting that the tubular stomach surgery have certain effects in inhibiting acid reflux, however, the effect is limited compared to the traditional surgical approach. There is significant non-acid reflux occurred in the two groups. The further comparison between the different body positions, the results show that the indexes are not statistically different, it indicates that the reflux occur after the tubular stomach surgery, regardless orthostatic or recumbent position, and non-acid reflux occurs more than acid reflux.Conclusion:MII-pH technology can comprehensively record and analyze postoperative esophageal reflux and the development process, as well as the symptoms caused by the reflux. The tubular gastric surgery in anti-reflux side has its limitation in esophageal reconstruction of digestive tract, furthermore, non-acid reflux gets a large proportion in the occurrence of postoperative reflux. |
PDF Full Text Request