| Objective: Esophageal cancer is originated in the esophageal squamous epithelium and columnar epithelial malignancies, in which the main pathological type of squamous cell carcinoma, accounting for about 90%. Esophageal cancer is a worldwide more common malignancies. Ours is a high incidence of esophageal cancer is also one of the highest fatality rate of esophageal cancer. Report of the World Cancer Statistics Cancer International Research Center showed: in 2002 the number of global incidence of approximately 462,000 people, male, female age-standardized incidence rate of esophageal cancer were 11.5 / 100,000 and 4.7 / 100,000. Among them, China’s highest incidence of esophageal cancer, age-standardized incidence rate for men and women were 27.4 / 100 000 and 12.0 / 100 000. Esophageal cancer is the most typical clinical manifestations of progressive dysphagia, the exact cause is not yet fully clear, but there are more of esophageal cancer associated with risk factors, such as amines and mycotoxins nitrate compounds, esophageal injury, esophageal disease, and food stimulation role of genetic factors as well. Sites of esophageal cancer in the esophagus-gastroesophageal junction between any part of the esophageal most, followed by the next segment, the segment least. Cancer cell proliferation and metastasis of esophageal inner wall of the main methods of diffusion, direct invasion of adjacent organs, lymph node metastasis and blood. Currently, the main treatment strategy for esophageal comprehensive treatment plan surgery and radiotherapy, chemotherapy combining. Surgery remains the primary and preferred treatment options. In recent years, surgical tubular esophagus stomach continues to progress, popularized in many hospitals. Compared generation esophageal compared to full stomach, which has many advantages, especially in reducing complications after baking. I have now been able to relatively good hospital to carry out on behalf of the tubular esophagus stomach surgical treatment of esophageal cancer, in order to further define the tubular esophagus stomach surgery surgical advantages compared to conventional full stomach esophagus, we will previous row by collecting Yan’an University Affiliated Hospital tubular stomach therapy patient data and patient data with a full stomach and esophagus traditional line treatment compared and concluded by the statistical analysis, provide clinicians with an objective in the next generation tubular stomach and esophagus treatment of esophageal cancer in medical practice clinical evidence.Methods: Since March 2010 to March 2013 in our hospital concurrent esophageal cancer surgery, a total of 80 cases. All patients were randomly divided into a treatment group and a control group of 40 patients, the treatment group underwent gastric generation of tubular esophagus surgery, the control group underwent conventional full stomach and esophagus surgery. Treatment group 22 males and 18 females, aged between 47 years old to be distributed in 69 years, the average age was 59.23 ± 2.3 years; control group, 23 were males and 17 females, aged between 49 distributed to 64 years, The average age of 58.67 ± 1.9 years. All patients in this study are in line with the established inclusion and exclusion criteria. Inclusion criteria: Patients were enrolled ⑴ informed consent for this study, and signed a voluntary consent; ⑵ all patients before surgery were confirmed by endoscopic biopsy and pathological diagnosis of esophageal cancer; ⑶ Supreme gastrointestinal surgery in all patients before surgery, no chronic a history of stomach ulcer; ⑷ surgery before the examination found no obvious radiographic evidence of tumor invasion and distant metastasis outside; ⑸ no serious heart, lung, liver, brain, kidneys and other vital organs organ dysfunction; ⑹ before surgery 3 within months of radiotherapy and / or chemotherapy did not undergo treatment; ⑺ patient consent after 1 year of follow-up were willing to accept; ⑻ patients with no other possible impact on the results of this study of diseases, such as history of mental illness, asthma, and relatively poor living habits such as overeating, alcoholism and other long-term heavy smokers. Exclusion criteria: ⑴ patients themselves or relatives refuse to participate in this clinical study; ⑵ esophageal tissue biopsy confirmed benign esophageal lesions, or can not be diagnosed with esophageal cancer; tumor before surgery ⑶ significant foreign invasion and / or distant metastasis radiographic evidence; ⑷ endoscopy confirmed the presence of acute gastritis, gastric ulcer exist, previous history of upper gastrointestinal surgery, and esophageal lesions invading cardia, fundus; ⑸ presence of important organs heart, lung, liver, brain, kidneys and other organ dysfunction or risk factors can not tolerate surgery; surgery three months ago ⑹ expert radiotherapy and / or chemotherapy treatment; ⑺ discharged lost to follow; ⑻ suffering may affect the results of the study of diseases, such as history of mental illness, asthma, as well as more bad habits such as overeating, alcoholism and other long-term heavy smokers. After underwent surgery for the merits of the two groups were observed after surgery the way, after 3 weeks, 6 months and 12 months, respectively, for all surgical patients were followed to investigate patients with reflux esophagitis, anastomotic leakage, anastomotic narrow mouth, stomach and chest syndrome cases and quality of life after surgery. Among them, evaluate whether the thoracic stomach syndrome, accounts for maximum ventilation after 1h percentage of the predicted value(MVV%) by measuring the eating, the first one second ventilation accounts for the percentage of the predicted value(FEV1%) and FVC percent predicted(VC%). Evaluation of quality of life after surgery, using the World Health Organization Quality of Life BREF form(Table 1) survey on the quality of life of patients and then compare scores.Results: The treatment group and the control group in all cases were satisfied with the surgery for esophageal lesions, no surgical mortality. Pathological examination showed: All 80 patients were esophageal squamous cell carcinoma. Postoperative complications: Reflux esophagitis: After three weeks, two groups of patients with reflux esophagitis was no significant difference in the incidence of postoperative June, December, reflux esophagitis incidence of treatment group was significantly lower than the control group. Anastomotic leakage: After three weeks, in June, the two groups appear incidence of anastomotic leakage was no significant difference after 12 months, anastomotic leak occurred in the control group was significantly higher than the treatment group. Anastomotic stricture: After three weeks, the treatment group and the control group were not there anastomotic stricture; after 6 months, 12 months, two anastomotic stricture was no significant difference in incidence. Thoracic stomach syndrome: after 3 weeks, 6 months and 12 months, the treatment group thoracic stomach syndrome detection indicators are significantly better than the control group. Quality of life after surgery: After three weeks, the two groups had no significant differences in quality of life after 6 months and 12 months, the overall quality of life indicators of the treatment group than the control group of patients.Conclusion: tubular esophagus stomach is way more popular esophageal cancer, compared to traditional full stomach esophagus surgical approach, he has more advantages, mainly for surgery, the long-term reflux esophagitis, anastomotic leak and anastomotic stricture lower incidence of postoperative thoracic stomach syndrome significantly lighter overall quality of life of patients was significantly higher than in patients with a full stomach and esophagus surgery. But both anastomotic stricture was no significant difference in incidence. |
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