[1]滕飞,蔡华荣,尹哲,等.食管-胃颈部吻合方法的对比研究[J].中国微创外科杂志,2018,18(3):197-201.
　Teng Fei,Cai Huarong,Yin Zhe,et al.Comparative Study on Methods of Esophagogastric Cervical Anastomosis[J].Chinese Journal of Minimally Invasive Surgery,2018,18(3):197-201.
点击复制

食管-胃颈部吻合方法的对比研究()
分享到：

《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
18
期数:
2018年3期
页码:
197-201
栏目:
临床论著
出版日期:
2018-05-01

文章信息/Info

Title:
Comparative Study on Methods of Esophagogastric Cervical Anastomosis
作者:
滕飞; 蔡华荣; 尹哲; 周洪; 江跃全**
重庆大学附属肿瘤医院重庆市肿瘤研究所重庆市肿瘤医院胸外科，重庆400030
Author(s):
Teng Fei;  Cai Huarong;  Yin Zhe;  et al.
Department of Thoracic Surgery, Chongqing University Cancer Hospital, Chongqing Cancer Institute, Chongqing Cancer Hospital, Chongqing 400030, China
关键词:
食管癌; 颈部吻合; 吻合口漏; 吻合口狭窄; 胃食管返流
Keywords:
Esophageal cancer; Cervical anastomosis; Anastomotic leakage; Anastomotic stenosis; Gastroesophageal reflux
文献标志码:
A
摘要:
目的探讨一种新的食管-胃颈部吻合方法在胸、腹腔镜联合下食管癌根治术中的应用价值。方法2014年10月~2016年1月我中心完成232例胸、腹腔镜联合下食管癌根治术。根据不同的颈部吻合方式分为2组：新式吻合组（颈部端端-侧侧-套入式吻合）68例，传统吻合组（以圆形吻合器做颈部端-侧吻合）164例，2组患者均采用胸、腹腔镜联合切口，胃-食管颈部吻合，仅颈部吻合方式不同。比较2组主要并发症（吻合口漏、吻合口瘢痕狭窄、胃食管返流）、手术时间、术中出血量、术后住院时间等情况。结果2组手术时间分别为(223.5±42.4)、（213.7±39.8）min，无统计学差异（t=1.675，P=0.095）；术中出血量分别为（83.4±24.2）、(87.6±27.3)ml，无统计学差异（t=-1.102，P=0.272）；术后住院时间分别为（12.2±35）、（12.8±6.0）d，无统计学差异（t=-0.771，P=0.441）；吻合口漏发生率分别为1.5%(1/68)、8.5%(14/164)，无统计学差异（χ2=2.886，P=0.089）；新式吻合组吻合口狭窄发生率1.5%(1/68)，明显低于传统吻合组12.2%(20/164)（χ2=6.716,P=0.010）；新式吻合组胃食管返流发生率5.9%(4/68)，明显低于传统吻合组18.3%(30/164) （χ2=5.919，P=0.015）。结论端端-侧侧-套入式吻合技术安全、可行，吻合口常见并发症（吻合口狭窄、消化液返流）发生率低，值得临床进一步推广。
Abstract:
ObjectiveTo discuss the application value of a new method of esophagogastric cervical anastomosis in esophageal cancer radical surgery under thoracoscopy and laparoscopy. MethodsA total of 232 cases of radical resection of esophageal cancer under thoracoscopy and laparoscopy from October 2014 to January 2016 were studied. They were divided into two groups according to different methods of anastomosis: the new method group (end to endside to sideinvagination anastomosis, n=68) and the triditional group (end to side anastomosis by using a circular stapler, n=164). Both groups of patients were performed by thoracic laparoscopic surgery of esophagogastric cervical anastomosis, only in different anastomosis methods. The postoperative complications, operation time, blood loss, and postoperative hospital stay were compared between the two groups.ResultsThe operation time was not significantly different between the two groups ［(223.5±42.4) min vs. (213.7±39.8) min, t=1.675, P=0.095］. The blood loss was not significantly different between the two groups ［(83.4±24.2) ml vs. (87.6±27.3) ml, t=-1.102, P=0.272］. The postoperative hospital stay was not significantly different between the two groups ［(12.2±3.5) d vs. (12.8±6.0) d, t=-0.771, P=0.441］. The incidence of anastomotic leakage was 1.5% (1/68) in the new method group and 8.5% (14/164) in the triditional group, without significant difference (χ2=2.886, P=0.089). The incidence of anastomosis stenosis was significantly lower in the new method group than that in the triditional group ［1.5%(1/68) vs. 12.2%(20/164), χ2=6.716, P=0.010］. The incidence of gastroesophageal reflux was significantly lower in the new method group than that in the triditional group ［5.9% (4/68) vs. 18.3% (30/164), χ2=5.919, P=0.015］.ConclusionThe end to endside to sideinvagination anastomosis can prevent the main two complications (anastomosis stenosis and gastroesophageal reflux) of anastomosis effectively,which is worthy of clinical application.

参考文献/References:

[1]Kollarova H, Machova L, Horakova D, et al. Epidemiology of esophageal cancer-an overview article. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub,2007,151(1):17-20.
[2]Siegel R, Ma J, Zou Z, et al. Cancer statistics. CA Cancer J Clin,2014,64(1):9-29.
[3]Kato H, Fukuchi M, Miyazaki T, et al. Surgical treatment for esophageal cancer. Current issues. Dig Surg,2007,24(2):8-25.
[4]Kato H, Nakajima M. Treatments for esophageal cancer: a review. Gen Thorac Cardiovasc Surg,2013,61(6):330-335.
[5]钱斌，王道猛，吴俊，等.微创食管癌根治术105例临床分析.中国微创外科杂志，2015，15(11):968-969.
[6]Biere SS, Maas KW, Cuesta MA, et al. Cervial or thoracic anastomosis after esophagectomy for cancer: a systematic review and metaanalysis. Dig Surg,2013,28(3):29-35.
[7]张霓，徐沁孜，蔡奕欣,等.全胸腔镜食管癌外科治疗的手术模式及其演变.中华胸心血管外科杂志,2013,29(6):323-357.
[8]陈刚，谢亮，唐继鸣,等.食管癌术后颈部吻合口纵隔胸腔内漏的诊治——附5例文献报告及文献复习.癌症,2005,24（10）：1280-1283.
[9]Haverkamp L, van der Sluis PC, Ruurda JP, et al. Endtoend versus endtoside esophagogastrostomy after esophageal cancer resection: a prospective randomized study. Ann Surg,2014,259(1):6-7.
[10]高旭辉，刘雷庭，朱永波，等.食管癌患者食管-管状胃环形吻合器端侧吻合与半器械侧侧吻合近期治疗效果观察.临床外科杂志,2015,23(4):305-307.
[11]Amstrong D, Bnnett JR, Blum AL, et al. The endoscopic assessment of esophagitis: a progress report on observer agreement.Gastroenterology,1996,111(1):85-92.
[12]Urschel JD. Esophagogastrostomy anastomotic leaks complicating esophagectomy: a review. Am J Surg,1995,169(6):634-640.
[13]Lam TC, Fok M, Cheng SW, et al. Anastomotic complications after esophagectomy for cancer. A comparison of neck and chest anastomoses. J Thorac Cardiovasc Surg,2013,104(2):395-400.
[14]Muller JM, Erasmi H, Stelzner M, et al. Surgical therapy of oesophageal carcinoma. Br J Surg,2014,77(8):845-857.
[15]Patil PK, Patel SG, Mistry RC, et al. Cancer of the esophagus: esophagogastric anastomotic leaka retrospective study of predisposing factors. J Surg Oncol,1992,49(3):163-167.
[16]Honda M, Kuriyama A, Noma H, et al. Handsewn versus mechanical esophagogastric anastomosis after esophagectomy: a systematic review and metaanalysis. Ann Surg,2013,257(2):238-248.
[17]Hulscher JB, Tijssen JG, Obertop H, et al. Transthoracic versus transhiatal resection for carcinoma of the esophagus: a metaanalysis. Ann Thorac Surg,2001,72(1):306-313.
[18]Enzinger PC, Mayer RJ. Esophageal cancer. N Engl Med,2003,349(23):2241-2252.
[19]Wu PC, Posner MC. The role of surgery in the management of oesophageal cancer. Lancet Oncol,2003,4(8):481-488.

备注/Memo

备注/Memo:
基金项目：2016年度中国癌症基金会北京希望马拉松基金立项课题（LC2016W03）**通讯作者，E-mail:12700205@qq.com
更新日期/Last Update: 2018-05-10