[Comparison of duodenogastric reflux (DGR) to esophageal substitute between retro-sternal route and posterior mediastinal route].
To elucidate superiority of route among surgery of esophageal cancer with stomach tube, duodenogastric reflux (DGR) were examined in nine cases of retro-sternal bypass (RS) and 18 cases of posterior mediastinal group (PM) by means of questionnaire of reflux esophagitis, esophageal transit scintigram and 24 hour pH monitoring to those patients. Firstly, in order to readily compare the two groups, each section of reflux symptoms was expressed as a brief score by dividing each symptom into strength (0-3) and frequency (0-3). Mean score of reflux sensation was less in RS than in PM significantly (0.9 vs. 2.9, p < 0.01). The median value showed that patients in PM had much DGR symptoms than those in RS significantly (8.5 vs. 5.5, p < 0.01). In esophageal transit scintigram, TcO4- (85 MBq) was counted by gamma camera at the upper (ROI-1), center (ROI-2), and lower (ROI-3) sites of the sternum bone in the upright position. The descending time of RI peak from ROI-1 to ROI-3 in RS was shorter than PM (2.1 sec vs. 3.9 sec, N.S.). At ROI-2, clearance rate of RI in RS was similar to that in PM. At ROI-3, clearance rate of RI in RS was better than that in PM significantly (80.0% vs. 49.6%, p < 0.05). Scintigram revealed RI stasis in PM, which might be presumably concerned to DGR. Intragastric pH was measured continuously 5 and 15 cm below the esophagogastrostomy using 2-channeled antimony pH sensors.(ABSTRACT TRUNCATED AT 250 WORDS)
Yamashita
Y
Y
Department of Surgery, Hiroshima University, Japan.
Hirai
T
T
Saeki
S
S
Yoshimoto
A
A
Noma
K
K
Toge
T
T
D004383:Duodenogastric Reflux / Q000503:physiopathology*; D004938:Esophageal Neoplasms / Q000503:physiopathology / Q000601:surgery*; D004944:Esophagoplasty / Q000379:methods*; D005260:Female; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008297:Male; D008482:Mediastinum / Q000601:surgery; D008875:Middle Aged; D008991:Monitoring, Physiologic; D013249:Sternum / Q000601:surgery