探讨SiewertⅡ/Ⅲ型胃食管连接部腺癌采用两种手术方式术后发生胃食管反流病的对比研究。

选择华润武钢总医院2012年1月至2014年12月明确诊断为SiewertⅡ/Ⅲ型胃食管连接部腺癌患者46例，随机分为两组，其中A组22例采用腹腔镜下近端胃部分切除＋食管残胃吻合＋幽门成形手术方式，B组24例采用腹腔镜下全胃切除＋食管空肠Roux-en-Y手术方式，通过监测两组患者胃肠引流量、食管下端pH值等指标，结合患者术后胸骨后烧灼痛、胆汁性呕吐、体重减轻等一系列临床症状，对两组患者反流性食管炎进行对比研究。

术后B组胃肠引流液量显著低于A组(P<0.05)，术后监测食管pH<4的总时间B组显著优于A组(P<0.05)，术后1周观察剑突下持续烧灼痛、体重较术前减轻、胆汁性呕吐等反流性食管炎发生率比较，B组均显著低于A组(9.1% vs.63.6%，P<0.05)。

B组在胃肠引流量、食管pH值、术后不良反应发生率等方面存在明显优势。

To compare the condition of gastroesophageal reflux disease(GERD) after two types of surgeries for Siewert Ⅱ/Ⅲ type gastroesophageal junction adenocarcinoma.

From January 2013 to December 2014, patients in Affilated Hua Run General Hospital of Wuhan Steal Company, diagnosed as Siewert Ⅱ/Ⅲ type AEG were randomly divided into two groups. Group A, laparoscopic resection of the proximal part of the stomach + esophagus residual anastomosis + pyloroplasty; group B, laparoscopic gastrectomy + esophagus jejunum Roux-en-Y surgery, by monitoring gastrointestinal drainage volume, esophageal pH value, burning pain under sternum, bile vomiting, weight loss and a series of clinical symptoms, two groups of patients with reflux esophagitis were compared.

Postoperative gastrointestinal drainage was significantly lower in group B than in group A (P<0.05), the total amount of time for postoperative esophageal pH<4 was less in group B than in group A (P<0.05). One week after surgery, postoperative epigastric burning pain, weight loss compared with preoperative condition, bilious vomiting, and reflux esophagitis incidence in group B were significantly lower than in group A (9.1% vs.63.6%, P<0.05) .

Group B is superior to group A in gastrointestinal drainage volume, esophageal pH value, and the incidence of adverse reactions.