[1]杨力涛① 洪志暖 林智伟 童杖伟 林文伟 谢舒涵 林与康 康明强 张振阳 林江波**.胸锁乳突肌肌瓣包埋降低食管癌术后颈部吻合口纵隔/胸内漏的临床研究[J].中国微创外科杂志,2023,01(1):14-19.
　Yang Litao,Hong Zhinuan*,Lin Zhiwei*,et al.Clinical Effect of Sternocleidomastoid Muscle Flap Embedding on Anastomotic Mediastinal/Thoracic Leakage After Minimally Invasive Esophagectomy[J].Chinese Journal of Minimally Invasive Surgery,2023,01(1):14-19.
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胸锁乳突肌肌瓣包埋降低食管癌术后颈部吻合口纵隔/胸内漏的临床研究()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
01
期数:
2023年1期
页码:
14-19
栏目:
临床研究
出版日期:
2023-01-25

文章信息/Info

Title:
Clinical Effect of Sternocleidomastoid Muscle Flap Embedding on Anastomotic Mediastinal/Thoracic Leakage After Minimally Invasive Esophagectomy
作者:
杨力涛① 洪志暖 林智伟 童杖伟 林文伟 谢舒涵 林与康 康明强 张振阳 林江波**
(福建医科大学附属协和医院胸外2科，福州350001)
Author(s):
Yang Litao;  Hong Zhinuan*;  Lin Zhiwei*;  et al.
*Second Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China
关键词:
胸锁乳突肌肌瓣包埋; 吻合口纵隔/胸内漏; 吻合口漏; 食管癌
Keywords:
Sternocleidomastoid muscle flap embedding; Anastomotic mediastinal/thoracic leakage; Anastomotic leakage; Esophageal cancer
文献标志码:
A
摘要:
目的探讨胸锁乳突肌肌瓣包埋降低食管癌术后颈部吻合口纵隔/胸内漏的有效性和安全性。方法回顾性分析2020年5月~2021年4月2个医疗组微创食管癌根治手术(minimally invasive esophagectomy，MIE)63例资料，一组行胸锁乳突肌肌瓣包埋(包埋组)(n=33)，另一组行常规手术(传统组)(n=30)。2组患者基线资料差异无统计学意义(P>005)。比较2组术中出血量、术后颈部出血、术后住院时间、胸腔及颈部引流管留置时间、再次手术、术后肺炎、声音嘶哑、吞咽困难、头颈部活动、吻合口漏及吻合口纵隔/胸内漏。结果与传统组相比，包埋组吻合口纵隔/胸内漏发生率低(0/33 vs. 4/30，P=0.046)，颈部引流管留置时间短［6.0(2~15)d vs. 9.0(3~29)d，Z=-2.929，P=0.003］，术后住院时间短［9.0(7~57)d vs. 13.0(7~32)d，Z=-2.867，P=0.004］，但头颈部活动满意度评分差［10.0(7~10)分 vs. 10.0(10~10)分，Z=-2.271，P=0.023］。2组术中出血量，淋巴结清扫数目，胸腔引流管留置时间，术后吻合口漏、肺炎、声音嘶哑、吞咽困难发生率，术后颈部疼痛感评分和头颈部活动度对生活的影响程度评分，再次手术率差异均无统计学意义(P>0.05)。2组均无术后颈部出血，无30天内死亡及再次住院。结论根据初步经验，胸锁乳突肌肌瓣包埋术安全，可减少食管癌术后颈部吻合口纵隔/胸内漏。
Abstract:
ObjectiveTo explore the efficacy and safety of sternocleidomastoid muscle flap embedding in reducing cervical anastomotic mediastinal/thoracic leakage after esophageal cancer operation.MethodsA total of 63 patients who underwent minimally invasive esophagectomy (MIE) in our department from May 2020 to April 2021 were divided into two groups: sternocleidomastoid muscle flap embedding group (experimental group, n=33) and routine operation group (control group, n=30). There was no significant difference in baseline data between the two groups (P>0.05). The intraoperative blood loss, postoperative cervical bleeding, postoperative hospital stay, indwelling time of thoracic drainage tube and cervical drainage tube, reoperation rate, the incidence of postoperative pneumonia, hoarseness and dysphagia, postoperative neck movement, postoperative anastomotic leakage, and anastomotic mediastinal/thoracic leakage were analyzed between the two groups.ResultsCompared with the control group, the experimental group had a lower incidence of anastomotic mediastinal/thoracic leakage (0/33 vs. 4/30, P=0.046), a shorter duration of neck drain retention ［6.0 (2-15) d vs. 9.0 (3-29) d, Z=-2.929, P=0.003］, and a shorter postoperative hospital stay ［90 (7-57) d vs. 13.0 (7-32) d, Z=-2.867, P=0.004］, but worse head and neck mobility satisfaction scores ［10.0 (7-10) vs. 10.0 (10-10), Z=-2.271, P=0.023］. There were no statistically significant differences between the two groups in intraoperative bleeding, number of lymph node dissections, duration of chest tube retention, postoperative anastomotic leakage, pneumonia, hoarseness, dysphagia, postoperative neck pain perception scores and reoperation rate (all P>005). There was no postoperative neck bleeding, no death within 30 days and no rehospitalization in both groups. ConclusionAccording to the preliminary experience, the sternocleidomastoid muscle flap embedding is safe and can reduce cervical anastomotic mediastinal/thoracic leakage after MIE.

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备注/Memo

备注/Memo:
基金项目：福建省自然科学基金面上项目(2020J01997)；福建省教育厅中青年教师教育科研项目(科技类)(JAT190194)；福建医科大学启航基金一般项目(2019QH1023)**通讯作者，Email：135279779@qq.com ①(陕西省宝鸡市中医医院外四科，宝鸡721000)
更新日期/Last Update: 2023-04-23