Esophageal Manometry And 24 Hour PH Monitoring Preoperatively And Postoperatively In Patients With Esophageal Carcinoma

PrefaceIn clinical, esophageal stricture with swallowing difficulty caused by esoph-ageal benign or malignant disease often needs to resect the lesion and rebuild the esophagus by surgical operation. But the end to end anastomosis after resecting is almost impossible due to the esophageal characteristic of segmental blood supply. So it is necessary to find a suitable substitute to rebuild the digestive continuity. At present, the common clinical substitutes include celiac organs such as stomach, colon or jejunum, but this type of surgical operation is complicated and the wound is big. Patients'long-term living quality is bad because of the operative damage in patients'function of digestion, respiration, circulation and reflux esophagitis. So we are trying to find a suitable subsitute to rebuild the digestive continuity. This research observes the changes of esophageal pressure and PH by esophageal manometry and 24 hour PH monitoring in preoperative and postoperative patients with esophageal carcinoma and in normal peoples in order to find reference for further esophageal replacement study.Materials and Methods1 Materials1.1 Subjects: healthy adults and clinical patients with esophageal carcinoma.1.2 Appliances: Static esophageal manometric instrument ( synectics pcpolygraf) , portable synectics Digitrapper MKffl PH monitor. 2 Methods2.1 Esophageal manometry: Before manometry, subjects need to fast at least 6 hours, and don't take medicine which can affect esophageal motivity. The trier joins the instrument to the pipe and correct the sensor then insert the pipe into the subject's stomach through his nasal cavity. Adopting fixed-point method to pull the pipe to measure the pressure of LES, UES and the function of esophageal body .2.2 24 hour esophageal PH monitoring : After opening the power of PH monitor, firstly, correct the electrode, place and fix the monitoring electrode 5cm above the subjects LES through his nasal carity. Then open PH moitoring procedure to record the 24 hour variation of esophageal PH. The subject must a-void eating acidic food during monitoring.Experimental resultsThe pressure of lower esophageal sphincter and the results of 24 hour PH monitoring of the preoperative group are higher than that of the normal group. But there is no statistical difference. The results of 24 hour monitoring in the postoperative group are higher than those of the preoperative group, and there is remarkable statistical difference.DiscussionsBoth lower esophagus and upper esophagus have functional sphincter generally. There are a lot of factors of preventing reflux in physiological condition. In lower esophagus, including the lower esophageal sphincter, the His cornu, the astricting function of midriff cornu, the fixing function of midriffesophageal ligament and pressure difference of esophagus between the chest segment and the belly segment, et al. And the function of lower esophageal sphincter plays a primary function in preventing gastroesophageal reflux and this function has been proven by a lot of researches. In clinical, the common method to treat esophage-al carcinoma is resecting the lesion and esophagus beneath it and reconstructing esophagus with stomach, colon and jejunum. But the question of poor life quality after operation has caused peoples universal attention, gastroesophageal reflux is the primary reason affecting the life quality after operation. Before operation, 3 cases have symptoms of reflux, which can be relieved by using medicine. 10 cases have symptoms of reflux after operation, the rest 5 cases do not exist reflux by monitoring. The results of 24 hour PH monitoring after resection are higher than those preoperatively, there are remarkable statistical differences. The main reason is the damage of esophageal function in preventing reflux after operation, such as the function of midriff cornu, His cornu esophageal in abdomen and lower esophageal sphincter have been destroied and there is a common cavity between the rest esophageal and stomach. Patients with esophageal carcinoma after operation can not avoid gastroesophageal reflux when there is no anastomotic stricture.ConclusionGastroesophageal reflux exists extensively in patients with esophageal carcinoma after operation because of the damaging mechanism of preventing reflux.