本文選題：食管癌　切入點(diǎn)：胃動(dòng)素　出處：《河北醫(yī)科大學(xué)》2015年碩士論文

【摘要】：目的:研究食管癌術(shù)后胸腔胃的功能。食管癌是常見(jiàn)的惡性腫瘤之一,外科手術(shù)治療已經(jīng)成為其首選的治療方式。按照國(guó)際抗癌聯(lián)盟(union for international cancer control UICC)食管癌的分段標(biāo)準(zhǔn),食管癌可分為食管胸上段癌,距離門(mén)齒20-25cm;食管胸中段癌,距離門(mén)齒25-30cm;食管胸下段癌,距門(mén)齒30-40cm。但是,無(wú)論腫瘤處于食管胸上段、胸中段還是胸下段,外科手術(shù)治療時(shí),不僅切除食管大部、食管胃結(jié)合部甚至切除近端胃,而且切斷支配胃的神經(jīng),胃的全部或大部由正壓的腹腔轉(zhuǎn)移至負(fù)壓的胸腔,不可避免的破壞固有的解剖結(jié)構(gòu),導(dǎo)致殘留食管、胸胃的結(jié)構(gòu)和功能的變化,如胃食管反流(gsatro-esophageal reflux GER)、吞咽順應(yīng)性降低、燒心等癥狀,嚴(yán)重影響患者術(shù)后生活質(zhì)量。因此,了解食管癌術(shù)后患者胸腔胃功能,對(duì)于改善其術(shù)后癥狀、提高術(shù)后生活質(zhì)量至關(guān)重要。但多數(shù)學(xué)者的資料來(lái)源于患者術(shù)后的主觀敘述,本研究擬通過(guò)研究食管癌術(shù)后胸腔胃胃酸分泌的變化,并且對(duì)患者空腹血液中胃動(dòng)素、胃泌素水平進(jìn)行檢測(cè),以期了解食管癌術(shù)后胸腔胃胃酸分泌變化對(duì)胸腔胃消化功能的影響。方法:本實(shí)驗(yàn)選取省四院胸外科和深州市醫(yī)院2008年9月-2009年9月期間,行食管癌根治術(shù)的患者35例,其中男性22例,女性13例,年齡45-72歲,平均年齡65.4歲。該35例患者符合入組條件,均屬于鱗狀細(xì)胞癌。另設(shè)15例無(wú)消化道病變住院患者做正常對(duì)照,其中男性9例,女性6例,平均年齡為64.5歲。將35例病人分為術(shù)前、術(shù)后1個(gè)月、3個(gè)月、6個(gè)月及12個(gè)月,共5組。以胃液量、基礎(chǔ)胃酸分泌量(basal acid output BAO)、胃液p H值作為胸胃功能的指標(biāo),測(cè)定患者術(shù)前術(shù)后胃液量、基礎(chǔ)胃酸分泌量及胃液p H值。同時(shí)對(duì)患者進(jìn)行采血,應(yīng)用放射免疫法測(cè)定受試者血漿中胃動(dòng)素和血清中胃泌素含量。統(tǒng)計(jì)學(xué)方法:應(yīng)用均數(shù)±標(biāo)準(zhǔn)差(x?s)表示,采用多元回歸分析患者術(shù)前、術(shù)后胃液量、基礎(chǔ)胃酸分泌量、胃液p H值變化。應(yīng)用配對(duì)t檢驗(yàn)(Paired Samples T test)分析食管癌術(shù)后1個(gè)月、3個(gè)月、6個(gè)月及12個(gè)月的術(shù)前、術(shù)后胃液p H值變化,同時(shí)將空腹血液的胃動(dòng)素、胃泌素變化參數(shù)進(jìn)行Spearman’s相關(guān)分析。數(shù)據(jù)采用Graph Pad Prism5.01軟件進(jìn)行分析,以點(diǎn)狀圖分布表示,一個(gè)點(diǎn)表示一個(gè)樣本,采用配對(duì)t檢驗(yàn)比較胃酸p H術(shù)前術(shù)后變化有無(wú)統(tǒng)計(jì)學(xué)意義,以P0.05為在統(tǒng)計(jì)學(xué)上有顯著性差異,以P0.01為在統(tǒng)計(jì)學(xué)上有極顯著性差異。結(jié)果:1胸胃泌酸功能變化1.1食管癌患者術(shù)后1個(gè)月胃液量及基礎(chǔ)胃酸分泌量明顯降低,與術(shù)前組患者相比,差異有統(tǒng)計(jì)學(xué)意義(P0.001)。術(shù)后3個(gè)月胃液及基礎(chǔ)胃酸分泌量仍低于術(shù)前組,差異有統(tǒng)計(jì)學(xué)意義(P0.001)。術(shù)后6個(gè)月較術(shù)后3個(gè)月有所上升,但與術(shù)前組對(duì)比,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。術(shù)后12個(gè)月與術(shù)前組相比,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),表明胃液量與基礎(chǔ)胃酸分泌量在術(shù)后一年恢復(fù)至正常水平。1.2食管癌術(shù)后一月胃液p H值顯著上升,與術(shù)前相比,有統(tǒng)計(jì)學(xué)意義(P0.001,P=0.00025)。術(shù)后3個(gè)月胃液p H值仍呈現(xiàn)上升趨勢(shì),高于術(shù)前對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義(P0.001,P=0.00046)。術(shù)后6個(gè)月值較術(shù)后3個(gè)月有所下降,但仍高于術(shù)前組,差異有統(tǒng)計(jì)學(xué)意義(P0.001,P=0.00032)。胃液p H值術(shù)后1年上述指標(biāo)恢復(fù)至術(shù)前對(duì)照組水平,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05,P=0.065)。2血液胃動(dòng)素、胃泌素測(cè)定結(jié)果2.1空腹血漿胃動(dòng)素水平:正常對(duì)照組患者血漿胃動(dòng)素含量在試劑盒說(shuō)明書(shū)提供的參考值范圍內(nèi),分析數(shù)值與試劑盒說(shuō)明書(shū)所提供的參考值無(wú)顯著差異(P0.05,P=0.074血漿胃動(dòng)素正常參考值為253.16±68.24p)。術(shù)前對(duì)照組高于正常對(duì)照組(P0.001,P=0.00067)。患者術(shù)后1個(gè)月血漿胃動(dòng)素水平明顯高于術(shù)前對(duì)照組,具有統(tǒng)計(jì)學(xué)意義(P0.001,P=0.00058)。術(shù)后3個(gè)月,胃動(dòng)素水平呈現(xiàn)下降趨勢(shì),但胃動(dòng)素水平高于術(shù)前對(duì)照組,且具有統(tǒng)計(jì)學(xué)意義術(shù)(P0.001,P=0.00024)。術(shù)后6個(gè)月胃動(dòng)素水平逐漸恢復(fù)至正常對(duì)照組水平,但仍高于正常對(duì)照組(P0.05,P=0.055)。術(shù)后1年患者血漿胃動(dòng)素水平降至正常對(duì)照組水平,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05,P=0.055)。2.2空腹血清胃泌素水平:正常對(duì)照組患者血清胃泌素濃度與說(shuō)明書(shū)所提供的正常參考值無(wú)明顯差別(P0.05,P=0.076,血清胃泌素正常參考值為20-160ng/L);術(shù)前對(duì)照組高于正常對(duì)照組(P0.05,P=0.042)。術(shù)后1個(gè)月血清胃泌素水平明顯高于術(shù)前對(duì)照組,具有統(tǒng)計(jì)學(xué)意義(P0.001,P=0.00021)。術(shù)后3個(gè)月,胃泌素水平呈現(xiàn)下降趨勢(shì),但胃泌素水平高于正常對(duì)照組,且具有統(tǒng)計(jì)學(xué)意義術(shù)(P0.001,P=0.00036)。術(shù)后6個(gè)月血清胃泌素水平逐漸恢復(fù)至正常對(duì)照組(P0.05,P=0.041);術(shù)后1年,血清胃泌素水平降至術(shù)前對(duì)照組水平,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05,P=0.068)。3胸腔胃液p H值變化與血液胃動(dòng)素、胃泌素的相關(guān)性術(shù)后胸腔胃液量、基礎(chǔ)胃酸分泌量與胃液p H值、血漿胃動(dòng)素、血清胃泌素術(shù)后1個(gè)月水平呈負(fù)相關(guān)。胃液p H值的動(dòng)態(tài)變化與血漿胃動(dòng)素水平呈正相關(guān),與血清胃泌素水平變化呈正性相關(guān)。結(jié)論:1食管癌患者術(shù)后1個(gè)月胃液量及基礎(chǔ)胃酸分泌量明顯降低,術(shù)后3個(gè)月開(kāi)始上升,術(shù)后12個(gè)月基本恢復(fù)至術(shù)前水平。2食管癌患者術(shù)后1個(gè)月胃液p H值顯著上升,術(shù)后6個(gè)月后開(kāi)始下降,術(shù)后12個(gè)月恢復(fù)至術(shù)前水平。3食管癌患者術(shù)后1個(gè)月血漿胃動(dòng)素含量明顯上升,術(shù)后6個(gè)月開(kāi)始下降,術(shù)后12個(gè)月恢復(fù)至術(shù)前水平。4食管癌患者術(shù)后1個(gè)月血清胃泌素含量明顯上升,術(shù)后6個(gè)月開(kāi)始下降,術(shù)后12個(gè)月恢復(fù)至術(shù)前水平。5食管癌患者術(shù)前與術(shù)后空腹血漿胃動(dòng)素與血清胃泌素變化與胃液p H值的變化呈正相關(guān)。
[Abstract]:Objective : To study the function of thoracic stomach after operation of esophageal carcinoma . It is one of the most common malignant tumors . Surgical treatment has become the preferred treatment modality . The gastric juice content , gastric acid secretion and gastric juice p - H in the plasma of patients with esophageal cancer were analyzed by using the method of multiple regression analysis . The p - H value of gastric juice still increased in 3 months after operation , which was higher than that of the control group before operation ( P 0.001 , P = 0.0046 ) . The postoperative 6 - month value was lower than that in the preoperative group ( P = 0.001 , P = 0.000032 ) . There was no significant difference ( P0.05 , P = 0.065 ) . The levels of serum gastrin and gastrin in normal control group were not significantly different ( P0.05 , P = 0.074 , and the normal reference value was 253.16 鹵 68.24p ) . The control group was higher than that of the control group ( P0.001 , P = 0.00067 ) . The plasma levels in plasma were significantly higher in 1 month after operation than in the control group ( P < 0.001 , P = 0.0058 ) . At 3 months after operation , the level of gastric activity decreased , but the level of gastric activity was higher than that of the control group before operation ( P 0.001 , P = 0.0024 ) . At 6 months after operation , the level of gastric activity gradually recovered to the normal control group , but it was still higher than that of the normal control group ( P0.05 , P = 0.055 ) . There was no significant difference between the serum gastrin concentration and the normal reference value ( P0.05 , P = 0.076 , the normal reference value of serum gastrin was 20 - 160 ng / L ) . The control group was higher than that of the normal control group ( P0.05 , P = 0.042 ) . The serum gastrin levels were significantly higher in 1 month after operation than in the control group ( P < 0.001 , P = 0.0021 ) . The gastrin levels showed a decrease in gastrin levels in 3 months after operation , but gastrin levels were higher than those in the normal control group and had statistical significance ( P 0.001 , P = 0.0036 ) . The serum gastrin levels in patients with esophageal carcinoma were significantly lower than those in normal control group ( P0.05 , P = 0.068 ) .

【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類(lèi)號(hào)】：R735.1

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