| Objective: This study was conducted to look at the chest of the stomach function after surgery for esophageal cancer in the upper thoracic. The esophageal carcinoma is one of the familiar malignant tumor, which is the best therapeutic regimen for surgery. According to the UICC segmentation criteria, Esophageal cancer is divided into a cancer in the upper thoracic esophagus- the tumor incisors 20-25 cm distance; in the middle esophagus carcinoma- the tumor incisors 25-30 cm distance; in the lower esophageal carcinoma- the tumor incisors 30-40 cm distance. Regardless of the tumor at the upper segment of esophagus, middle or lower segment, Treatment for esophageal cancer surgery not only the integration of a most of resection of esophageal and stomach esophagus resection even proximal stomach, and cut off the control of the stomach, the stomach all or most of the positive pressure of the abdominal cavity to the negative pressure in the chest, however, the inherent anatomical structure of esophagus will be damaged during surgery and the residual esophagus will happen great change in physical and functional so that the patients appear some symptoms, such as gastric esophageal reflux, low swallowing compliance, heartburn and so on, seriously affect the quality of life of patients with these symptoms. Therefore, understanding after esophagectomy in patients with upper gastrointestinal pathological physiological changes, to improve the postoperative symptoms and improve the postoperative quality of life is very important. But most scholars of the data derived from patients with postoperative subjective narrative, Studied in this paper through studying the chest after esophagectomy for patients with the change of gastric acid secretion, and fasting blood gastric dynamic element, the laboratory level, in order to understand the chest after esophagectomy for patients with gastric acid secretion changes affect chest stomach digestive function.Methods: Thirty-five patients who ever underwent esophagectomy for cancer in the Department of Thoracic surgery, the Fourth Hospital, Hebei Medical University between September 2008 and September 2009 were selected randomly. There were 22 male and 13 female, with the mean age of 65.4 years. The above 35 patients who squamous cell carcinoma are eligible for the group. Another 15 subjects who had no symptoms form gastrointestinal tract were selected as controls, including 9 male and 6 female, mean age being 64.5 years. The gastric juice, basal acid output and p H values of gastric juice was tested with high-precision p H meter and gastrin and motilin in plasm were measured with radio-immunity assay before and 1, 3, 6 and 12 months after surgery. Amount of gastric juice, basal acid output, gastric juice p H value as index of thoracic stomach function, application at the same time, the blood of patients with ria method to determine the subjects stomach dynamic element in plasma and gastric secrete element content in the serum. Application mean + /- standard deviation said, using multiple regression analysis in patients with preoperative and postoperative gastric juice volume, gastric acid secretion, gastric juice p H changes. Paired t testwas used to analyse the changes of p H value in gastric juice. Spearman’s correlation analysis was used for motilin and gastrin in the blood. Data were analyzed by Graph Pad Prism5.01 software, and P<0.05 was condisdered as statistically significant difference.Results: 1 The changes of thoracic gastric acid secretion function 1.1 With the preoperative patients, the 1 months postoperatively in patients with esophageal carcinoma gastric juice quantity and BAO obviously decreased gastric acid secretion, the results there were significant differences(P<0.001). With the preoperative patients, After 3 months of quantity of gastric juice and BAO in patients with decreased obviously, the results there were significant differences(P<0.001). With the preoperative patients, After 6 months of quantity of gastric juice and BAO in patients with decreased obviously, the results there were differences(P<0.05). With the preoperative patients, After 12 months of quantity of gastric juice and BAO in patients with decreased obviously, the results were not differences(P>0.05). 1.2 p H values in gastric juice significantly increased 1 month after esophagectomy for cancer in when compared with the preoperative values. Further increase was found at 3 month after surgery and a litte decrease at 6th month after surgery but still higher than preoperative group. It recovered to the preoperative level of control group 1year after surgery. 2 The results of motilin and gastrin in blood 2.1 Motilin in plasma: There were no significant difference between normal control group and normal reference values that provided by the specification(P>0.05). The preoperative control group was higher than that in normal control group(P<0.001). The plasma motilin level was significantly higher than the preoperative control group 1 month after surgery(P<0.001).The motilin level decreased at 3 month after sugery but still higher than the normal control group(P<0.001). It further decreased to the normal control group level(P<0.05) 6 months after sugery and maintained to 1 year(P>0.05). 2.2 The levels of gastrin in serum: There were no significantv difference between normal control group and normal reference values that provided by the specification(P>0.05). The preoperative control group was higher than that in normal control group(P<0.001). The level of serum gastrin one month after surgery was significantly higher than the preoperative control group(P<0.001). The gastrin level decreased 3 month after sugery but still higher than the normal control group(P<0.001). The serum gastrin further decreased to the level of nromal control group 6 months after surgery(P<0.05). It still maintained at the level of normal control 1years after surgery(P>0.05). 3 Effects of motilin and gastrin on gastric acid p H changeThe changes of gastric juice, BAO after operation were negatively correlated with gastric juice p H value, plasma motilin and gastrin. The changes of p H in gastric juice after operation were positively correlated with plasma motilin and gastrin.Conclusions:1 After esophagectomy for cancer, Gastric juice volume and BOA decreased obviously from 1st month, starts increase from 3th month, and returns to preoperative level after 1 year.2 After esophagectomy for cancer, p H value in gastric acid increases from 1st month, starts decrease from 6th month, and returns to preoperative level after 1 year.3 After esophagectomy for cancer, The plasma motilin increases from 1st month, starts decrease from 6th month, and returns to preoperative level after 1 year.4 After esophagectomy for cancer, The serum gastric secrete element increases from 1st month, starts decrease from 6th month, and returns to preoperative level after 1 year.5 The plasma motilin and serum gastrin positively correlate with the changes of p H values in gastric juice agter esophagectomy for cancer. |
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