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

【摘要】：目的:研究食管癌術后胸腔胃的功能。食管癌是常見的惡性腫瘤之一,外科手術治療已經(jīng)成為其首選的治療方式。按照國際抗癌聯(lián)盟(union for international cancer control UICC)食管癌的分段標準,食管癌可分為食管胸上段癌,距離門齒20-25cm;食管胸中段癌,距離門齒25-30cm;食管胸下段癌,距門齒30-40cm。但是,無論腫瘤處于食管胸上段、胸中段還是胸下段,外科手術治療時,不僅切除食管大部、食管胃結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移至負壓的胸腔,不可避免的破壞固有的解剖結構,導致殘留食管、胸胃的結構和功能的變化,如胃食管反流(gsatro-esophageal reflux GER)、吞咽順應性降低、燒心等癥狀,嚴重影響患者術后生活質量。因此,了解食管癌術后患者胸腔胃功能,對于改善其術后癥狀、提高術后生活質量至關重要。但多數(shù)學者的資料來源于患者術后的主觀敘述,本研究擬通過研究食管癌術后胸腔胃胃酸分泌的變化,并且對患者空腹血液中胃動素、胃泌素水平進行檢測,以期了解食管癌術后胸腔胃胃酸分泌變化對胸腔胃消化功能的影響。方法:本實驗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,均屬于鱗狀細胞癌。另設15例無消化道病變住院患者做正常對照,其中男性9例,女性6例,平均年齡為64.5歲。將35例病人分為術前、術后1個月、3個月、6個月及12個月,共5組。以胃液量、基礎胃酸分泌量(basal acid output BAO)、胃液p H值作為胸胃功能的指標,測定患者術前術后胃液量、基礎胃酸分泌量及胃液p H值。同時對患者進行采血,應用放射免疫法測定受試者血漿中胃動素和血清中胃泌素含量。統(tǒng)計學方法:應用均數(shù)±標準差(x?s)表示,采用多元回歸分析患者術前、術后胃液量、基礎胃酸分泌量、胃液p H值變化。應用配對t檢驗(Paired Samples T test)分析食管癌術后1個月、3個月、6個月及12個月的術前、術后胃液p H值變化,同時將空腹血液的胃動素、胃泌素變化參數(shù)進行Spearman’s相關分析。數(shù)據(jù)采用Graph Pad Prism5.01軟件進行分析,以點狀圖分布表示,一個點表示一個樣本,采用配對t檢驗比較胃酸p H術前術后變化有無統(tǒng)計學意義,以P0.05為在統(tǒng)計學上有顯著性差異,以P0.01為在統(tǒng)計學上有極顯著性差異。結果:1胸胃泌酸功能變化1.1食管癌患者術后1個月胃液量及基礎胃酸分泌量明顯降低,與術前組患者相比,差異有統(tǒng)計學意義(P0.001)。術后3個月胃液及基礎胃酸分泌量仍低于術前組,差異有統(tǒng)計學意義(P0.001)。術后6個月較術后3個月有所上升,但與術前組對比,差異有統(tǒng)計學意義(P0.05)。術后12個月與術前組相比,差異無統(tǒng)計學意義(P0.05),表明胃液量與基礎胃酸分泌量在術后一年恢復至正常水平。1.2食管癌術后一月胃液p H值顯著上升,與術前相比,有統(tǒng)計學意義(P0.001,P=0.00025)。術后3個月胃液p H值仍呈現(xiàn)上升趨勢,高于術前對照組,差異有統(tǒng)計學意義(P0.001,P=0.00046)。術后6個月值較術后3個月有所下降,但仍高于術前組,差異有統(tǒng)計學意義(P0.001,P=0.00032)。胃液p H值術后1年上述指標恢復至術前對照組水平,差異無統(tǒng)計學意義(P0.05,P=0.065)。2血液胃動素、胃泌素測定結果2.1空腹血漿胃動素水平:正常對照組患者血漿胃動素含量在試劑盒說明書提供的參考值范圍內(nèi),分析數(shù)值與試劑盒說明書所提供的參考值無顯著差異(P0.05,P=0.074血漿胃動素正常參考值為253.16±68.24p)。術前對照組高于正常對照組(P0.001,P=0.00067)�；颊咝g后1個月血漿胃動素水平明顯高于術前對照組,具有統(tǒng)計學意義(P0.001,P=0.00058)。術后3個月,胃動素水平呈現(xiàn)下降趨勢,但胃動素水平高于術前對照組,且具有統(tǒng)計學意義術(P0.001,P=0.00024)。術后6個月胃動素水平逐漸恢復至正常對照組水平,但仍高于正常對照組(P0.05,P=0.055)。術后1年患者血漿胃動素水平降至正常對照組水平,差異無統(tǒng)計學意義(P0.05,P=0.055)。2.2空腹血清胃泌素水平:正常對照組患者血清胃泌素濃度與說明書所提供的正常參考值無明顯差別(P0.05,P=0.076,血清胃泌素正常參考值為20-160ng/L);術前對照組高于正常對照組(P0.05,P=0.042)。術后1個月血清胃泌素水平明顯高于術前對照組,具有統(tǒng)計學意義(P0.001,P=0.00021)。術后3個月,胃泌素水平呈現(xiàn)下降趨勢,但胃泌素水平高于正常對照組,且具有統(tǒng)計學意義術(P0.001,P=0.00036)。術后6個月血清胃泌素水平逐漸恢復至正常對照組(P0.05,P=0.041);術后1年,血清胃泌素水平降至術前對照組水平,差異無統(tǒng)計學意義(P0.05,P=0.068)。3胸腔胃液p H值變化與血液胃動素、胃泌素的相關性術后胸腔胃液量、基礎胃酸分泌量與胃液p H值、血漿胃動素、血清胃泌素術后1個月水平呈負相關。胃液p H值的動態(tài)變化與血漿胃動素水平呈正相關,與血清胃泌素水平變化呈正性相關。結論:1食管癌患者術后1個月胃液量及基礎胃酸分泌量明顯降低,術后3個月開始上升,術后12個月基本恢復至術前水平。2食管癌患者術后1個月胃液p H值顯著上升,術后6個月后開始下降,術后12個月恢復至術前水平。3食管癌患者術后1個月血漿胃動素含量明顯上升,術后6個月開始下降,術后12個月恢復至術前水平。4食管癌患者術后1個月血清胃泌素含量明顯上升,術后6個月開始下降,術后12個月恢復至術前水平。5食管癌患者術前與術后空腹血漿胃動素與血清胃泌素變化與胃液p H值的變化呈正相關。
[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 ) .

【學位授予單位】：河北醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R735.1

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