食管胃端端器械吻合与常规食管胃端侧器械吻合在食管胃交界部癌根治术中的临床疗效比较
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摘要
目的研究食管胃端端器械吻合与常规食管胃端侧器械吻合在食管胃交界部癌根治术中对吻合口并发症以及术后胃瘫的影响,并统计患者1年内的生存情况。方法选取2013年6月至2017年3月在宁阳县第一人民医院诊断为食管胃交界部癌的162例患者为研究对象,其中77例采用食管胃端侧器械吻合的患者定义为常规组; 85例采用食管胃端端器械吻合的患者定义为改良组。比较两组患者吻合口并发症的发生率、术后胃瘫的发生率以及1年生存情况。结果改良组术后吻合口瘘、吻合口狭窄的发生率均明显低于常规组[1. 2%(1/85)比10. 4%(8/77)、0%比7. 8%(6/77)](P <0. 05),而两组术后吻合口炎、术后胃瘫的发生率比较差异无统计学意义(P> 0. 05);两组随访1年内均无死亡病例。结论食管胃交界部癌切除后食管残胃的端端器械吻合,可有效减少吻合口瘘、吻合口狭窄的发生。同时因食管残胃的顺应性较好,有利于胃的排空,可有效减少胃瘫的发生,从而提高患者生活质量。
Objective To study the influence of esophagogastric end-to-end mechanical anastomosis and regular esophagogastric end-to-side mechanical anastomosis on incidence of anastomotic complications and postoperative gastric paralysis in the radical surgery of adenocarcinoma of esophagogastric junction,and record the 1-year survival. Methods A total of162 cases of adenocarcinoma of the esophagogastric junction were selected in the First People's Hospital of Ningyang County from Jun. 2013 to Mar. 2017. Among them,77 cases treated with esophagogastric end-to-side mechanical anatomosis were defined as regular group,85 cases treated with esophagogastric end-to-end mechanical anastomosis were defined as a modified group. The incidences of complications of anastomotic opening,postoperative gastric paralysis and 1-year survival situation of the two groups were compared. Results The incidence of postoperative anastomotic fistula and anastomotic stenosis in the modified group were significantly lower than that in the regular group[1. 2%( 1/85) vs 10. 4%( 8/77),0% vs7. 8%( 6/77) ]( P < 0. 05); there was no significant difference in the incidence of postoperative anastomotic inflammation and postoperative gastroparesis between the two groups( P > 0. 05); no deaths occurred in the two groups within 1 year of follow-up. Conclusion Esophagogastric end-to-end mechanical anastomosis can reduce the tension of anastomotic stoma,prevent anastomotic fistula and anastomotic stenosis. At the same time the esophagus remnant stomach' s compliance is good,which is good for stomach emptying and can effectively reduce the occurrence of gastric paralysis,thereby improves the patient life quality.
Objective To study the influence of esophagogastric end-to-end mechanical anastomosis and regular esophagogastric end-to-side mechanical anastomosis on incidence of anastomotic complications and postoperative gastric paralysis in the radical surgery of adenocarcinoma of esophagogastric junction,and record the 1-year survival. Methods A total of162 cases of adenocarcinoma of the esophagogastric junction were selected in the First People's Hospital of Ningyang County from Jun. 2013 to Mar. 2017. Among them,77 cases treated with esophagogastric end-to-side mechanical anatomosis were defined as regular group,85 cases treated with esophagogastric end-to-end mechanical anastomosis were defined as a modified group. The incidences of complications of anastomotic opening,postoperative gastric paralysis and 1-year survival situation of the two groups were compared. Results The incidence of postoperative anastomotic fistula and anastomotic stenosis in the modified group were significantly lower than that in the regular group[1. 2%( 1/85) vs 10. 4%( 8/77),0% vs7. 8%( 6/77) ]( P < 0. 05); there was no significant difference in the incidence of postoperative anastomotic inflammation and postoperative gastroparesis between the two groups( P > 0. 05); no deaths occurred in the two groups within 1 year of follow-up. Conclusion Esophagogastric end-to-end mechanical anastomosis can reduce the tension of anastomotic stoma,prevent anastomotic fistula and anastomotic stenosis. At the same time the esophagus remnant stomach' s compliance is good,which is good for stomach emptying and can effectively reduce the occurrence of gastric paralysis,thereby improves the patient life quality.
引文
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[16]夏晖,于长海,李捷,等.食管癌和贲门癌手术对呼吸功能影响的差异[J].胃肠病学和肝病学杂志,2010,19(11):1009-1011.
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[18]陈杰,宋劲松,张新民,等,管状胃经胸骨后颈部食管吻合治疗中段食管癌[J].肿瘤防治研究,2012,39(9):1160-1160.
[19]张明星,张新华.食管癌术后胃瘫综合征临床诊治分析[J].基层医学论坛,2016,20(7):889-890.
[20]程金华,王文光,高宗人,等.贲门癌不同术式的选择(附胃底折叠术治疗贲门癌193例报告)[J].中华肿瘤杂志,1995,17(6):444-446.
[21]刘江蕙,李建涛,贺宇彤,等.食管癌贲门癌患者T淋巴细胞、NK细胞免疫功能检测及意义[J].中国老年学杂志,2010,30(6):729-731.
[22]徐启明,周乃康,柳曦,等.食管癌贲门癌切除机械吻合术后胃食管反流的诊断和治疗[J].中国现代医学杂志,2011,30(7):166-167.
[2]Rice TW,Blacksstone EH,Rusch VW.7th edition of the AJCCCancer Staging Manual:Esophagus and esophagogastric junction[J].Ann Surg Oncol,2010,17(7):1721-1724.
[3]Fang WL,Wu CW,Chen JH,et al.Esophagogastric junction adenocarcinoma according to siewert classification in Taiwan[J].Ann Surgoncol,2009,16(12):2066-2073.
[4]程相方.食管床低负压引流在食管癌术后胸内吻合口瘘早期诊断及治疗中的应用[J].医学研究生学报,2017,30(1):88-99.
[5]田烨,周凌霄,任光国.1208例食管癌患者术后吻合口瘘风险因素分析[J].重庆医学,2014,43(15):1924-1927.
[6]Kumbhari V,Tieu AH,Ngamruengphong S,et al.Endoscopic management of stomal stenosis after Roux-en-Y gastric bypass[J].Gastrointest Endosc,2015,82(4):747.
[7]陈文树,付向宁,徐澄澄,等.管状胃对食管癌手术后胃食管反流的影响[J].华中科技大学学报(医学版),2011,40(5):593-596.
[8]Lanuti M,De Delva P,Morse CR,et al.Management of delayed gastric emptying after esophagectomy with endoscopic balloon dilatation of the pylorus[J].Ann Thorac Surg,2O11,91(4):1019-1024.
[9]孙斌,任正兵,丁国文.食管中上段癌-胃颈部分层吻合得临床研究[J].山西医药杂志,2012,41(11):1141-1142.
[10]何光杰,赖应龙,梅波,等.食管胃端端吻合在食管胃交界部癌切除术中的应用[J].川北医学院学报,2014,29(3):296-297.
[11]张明,张波,陈华增,等.不同管状消化道吻合器在食管胃吻合术中的应用[J].中国基层医药,2014,11(27):67-68.
[12]李会希.器械吻合和手工吻合在食管癌手术中的对比应用[J].河南医学高等专科学校学报,2015,27(5):591-592.
[13]吴斌,钱江平,刘潇.食道胃胸顶吻合和颈部吻合法在食管癌手术中的应用价值[J].中国地方病防治杂志,2017,32(3):315-317.
[14]车嘉铭,项捷,陈凯,等.管状胃在食管、贲门癌手术中的临床应用[J].中国胸心血管外科临床杂志,2010,17(2):96-98.
[15]付军科,张勇,李新举,等.管状胃在食管贲门癌手术中的临床应用[J].现代肿瘤医学,2012,20(10):2072-2074.
[16]夏晖,于长海,李捷,等.食管癌和贲门癌手术对呼吸功能影响的差异[J].胃肠病学和肝病学杂志,2010,19(11):1009-1011.
[17]张伟,罗宏伟,韩英杰.管状胃食管吻合术与传统食管胃弓上吻合术治疗食管癌的效果比较[J].医学综述,2017,23(23):4777-4780.
[18]陈杰,宋劲松,张新民,等,管状胃经胸骨后颈部食管吻合治疗中段食管癌[J].肿瘤防治研究,2012,39(9):1160-1160.
[19]张明星,张新华.食管癌术后胃瘫综合征临床诊治分析[J].基层医学论坛,2016,20(7):889-890.
[20]程金华,王文光,高宗人,等.贲门癌不同术式的选择(附胃底折叠术治疗贲门癌193例报告)[J].中华肿瘤杂志,1995,17(6):444-446.
[21]刘江蕙,李建涛,贺宇彤,等.食管癌贲门癌患者T淋巴细胞、NK细胞免疫功能检测及意义[J].中国老年学杂志,2010,30(6):729-731.
[22]徐启明,周乃康,柳曦,等.食管癌贲门癌切除机械吻合术后胃食管反流的诊断和治疗[J].中国现代医学杂志,2011,30(7):166-167.