食管上段颈段癌患者食管-胃颈部器械吻合的临床研究

Clinical study of esophagogastrostomy on patients suffering from carcinoma of esophagus at esophageal upper or cervical segment by anastomat

目的探索食管癌患者食管-胃颈部吻合术新的吻合方法,以减少食管癌患者食管-胃颈部手工吻合术后吻合口瘘和吻合口狭窄等并发症的发生率。方法随机选取两组食管上段、颈段癌患者,A组(实验组,器械吻合组)共20例(全部为上段、颈段癌),行左(或右)开胸食管癌切除加食管-胃左颈部器械吻合(闭合)术(GF-Ⅰ型吻合器、闭合器6例,GF-Ⅱ型吻合器、闭合器4例,强生25#直杆吻合器10例);B组(对照组,手工吻合组)共31例(含中段癌22例),也行左开胸食管癌切除加食管-胃左颈部手工吻合术(1#丝线间断缝合加浆肌层包埋)。结果A、B两组患者在手术平均吻合时间〔A:(15±5)min;B:(61±10)min,P<0.001〕、术后平均住院日〔A:(7±1)d;B:(12±3)d,P<0.001〕差异有非常显著性;近期吻合口瘘的发生率(A:0/20;B:3/31,P=0.271)、随访1～36个月吻合口狭窄的发生率(A:0/20;B:4/31,P=0.145)及肿瘤复发率(A:0/20;B:4/31,P=0.145),差异无显著性;而总并发症发生率(A:0/20;B:11/31,P=0.004)差异有非常显著性。结论如颈部所剩正常食管长度(一般应>2.0cm以上)许可,可用器械吻合方法来代替手工吻合方法行食管-胃颈部吻合术,从而缩短手术时间和减少患者术后并发症的发生。

Objective To try to find out a new kind of anastomotic method of esophagogastrostomy on cervical part so as to decrease incidences of complications of anastomotic leakage and stricture by manual anastomosis. Methods 41 patients suffering from carcinoma of esophagus at esophageal upper or cervical segment were divided into two groups at random ： the group A （ 20 patients） would have received the esophagogastrostomy on left or right cervical part, by using GF - Ⅰ or ⅡorsDH25 made in USA, after they had been resected esophageal carcinoma,while the group B （31 patients ） had only been done the esophagogastrostomy on left by manual suture （septal suture with silk thread,No 1. for adding seromuscular layer embedding）. Results There were statistical significances between group A and B in the mean time of anastomosis [ A：15 ± 5 min;B：61 ± 10 min,P 〈 0.001 and mean postoperative days of hospitalization （ A ：7 ± Ⅰ d ; B ： 12 ± 3 d, P 〈 0. 001 ） , there were not statistical significances between group A and B in the incidence of anastomotic leakage postoperatively （ A ： 0/20 ; B ： 3/31, P = 0.271 ） ; the incidence of stricture by follows -up from one to thirty -six months （A ：0/20;B ：4/31 ,P = 0. 145 ） and recurrence rate of cancer （A ：0/20; B：4/31 ,P = 0. 145） ,but there were also statistical significances between group A and B in the total incidence of complications （A ：0/20;B：1 1/31 ,P = 0.004）. Conclusion If only the condition permitted we could do esophagogastrostomy on cervical part by anastomat instead of manua suture so as to reduce the mean operation time and occurrence of complications.