探讨食管癌切除附加改良Nissen折叠术后残余食管黏膜上环氧化酶-2(COX-2)表达的意义。

对2013年12月—2015年7月徐州医科大学附属徐州市立医院胸外科收治的50例食管中下段癌患者按照随机对照试验原则分为抗反流吻合组和常规吻合组。常规吻合组实施食管癌切除食管胃常规吻合术，抗反流吻合组在实施常规吻合基础上附加改良Nissen折叠术，术后42例患者参加随访，并以10名无反流症状的健康志愿者为对照组。行胃镜检查观察残余食管黏膜形态学改变和黏膜活检，采用real-time PCR检测残余食管黏膜上COX-2基因的表达。

抗反流吻合组反流性食管炎的发生率为45%，常规吻合组为68.2%，两组间反流性食管炎的发生率无明显差别(P＝1.313)，而抗反流组反流性食管炎评分明显低于常规吻合组(P＝0.038)。正常对照组食管黏膜上COX-2呈现低水平表达，两组在胃镜下检查残余食管黏膜是否发生反流性食管炎的COX-2相对表达量均高于正常对照组(P＝0.031，P＝0.016)，而两组间无明显差别(P＝0.137)。常规吻合组和抗反流吻合组残余食管黏膜上COX-2的相对表达量均高于对照组(P＝0.002，P＝0.047)，而抗反流吻合组残余食管黏膜上COX-2表达明显低于常规吻合组(P＝0.036)。

食管癌切除附加改良Nissen折叠术具有抗反流的效果，检测残余食管黏膜上COX-2的表达变化是反应食管癌术后胃食管反流的灵敏指标，也可能是一种评估抗反流吻合效果的新方法。

To investigate the significance of cyclooxygenase-2 (COX-2) expression in the remnant esophageal mucosa after esophagectomy with modified Nissen folding anastomosis.

From December 2013 to July 2015, 50 patients with lower esophageal cancer who underwent thoracic surgery were divided into anti-reflux anastomosis group and conventional anastomosis group according to the principle of randomized controlled trial. The conventional anastomosis group was performed with esophageal cancer resection and esophagogastric anastomosis. The anti-reflux anastomosis group was modified with Nissen folding on the basis of anastomosis anastomosis. 42 patients were followed up, and 10 healthy volunteers without reflux symptoms were enrolled as the control group. Morphological changes and mucosal biopsy of residual esophageal mucosa were observed by gastroscopy. The expression of COX-2 gene in residual esophageal mucosa was detected by real-time PCR.

The incidence of reflux esophagitis in the anti-reflux anastomosis group was 45%, and that in the conventional anastomosis group was 68.2%. There was no significant difference in the incidence of reflux esophagitis between the two groups (P=1.313), while the score of reflux esophagitis in the anti-reflux group was significantly lower than that in the conventional group (P=0.038). The COX-2 expression of the esophageal mucosa in the control group was low, and the expression in the other two groups was higher than that in the control group (P=0.031, P=0.016). But there were no significant differences between these two groups (P=0.137). The COX-2 expression on the residual esophageal mucosa in the conventional anastomosis group and the anti-reflux anastomosis group was higher than that in the control group (P=0.002, P=0.047), while the expression in the anti-reflux anastomosis group was significantly lower than that in the conventional anastomosis group (P=0.036).

Esophageal cancer resection with modified Nissen folding has anti-reflux effect. Detection of COX-2 expression in residual esophageal mucosa is a sensitive indicator for postoperative gastroesophageal reflux in esophageal cancer, which is also a new method for evaluating the effect of anti-reflux anastomosis.