食管癌切除重建术管状胃及吻合口黏膜延长分层吻合临床效果评价

Clinical evaluation of gastric tube reconstruction and extended mucosa anastomosis in esophageal resection

目的探讨管状胃在食管癌切除重建术中的临床应用及其对术后生活质量的影响。方法将386例胸段食管癌患者分为管状胃组及对照组。管状胃组202例切除胃小弯侧形成管状胃,从食管裂孔经后纵隔食管床主动脉弓后方原位移至胸膜顶或左颈部行食管断端胃吻合术;对照组184例用全胃行移至胸膜顶或左颈部行食管断端胃吻合术。结果 386例患者均手术成功,顺利康复出院。管状胃组与对照组比较,肺功能的损失、吻合口瘘、吻合口狭窄、胸胃综合征及反流性食管炎等并发症发生率明显减少。结论管状胃食管替代重建术式更符合生理解剖的要求,在食管切除长度、扩大淋巴结清扫、减少术后并发症的发生、提高患者生活质量等诸多方而均符合肿瘤治疗原则。

Objective To evaluate the application of gastric tube reconstruction and and extended mucosa anastomosis in esophageal resection on the quality of life in esophageal carcinoma patients.Methods 386 cases were divided into gastric tube group and control group.In gastic tube group,202 patients after lesser curvature were cut,the gastric tube were reconstructed in the left neck or at the cupula of pleura via the postmediastinal route through esophageal hiatus.In control group,184 patients received anatomosis of esophageal ends with full stomach line moved to the top or left pleura.Results All 386 patients were recovered safely after operation.The incidence of loss of pulmonary function 、 anastomotic leak、 anastomotic stenosis、 thoracogastric syndrome and reflux esophagitis in gastric tube group were obviously decreased.Conclusion The procedure of gastric tube reconstruction fit physiologicoanatomical function of the digestive tract.It is in conformity with the therapeutic principle of tumor in terms of the length of esophageal resection,expanding lymph node dissection,reducing the incidence of postoperative complications and improve living quality of patients.