胃食管右胸膜顶吻合在食管癌根治术中的应用

Effect of right thoracic suprathoracic anastomosis on radical operation for esophageal cancer

目的探讨食管中下段癌根治术中,右侧开胸胃食管胸膜顶吻合术式与传统的左侧开胸胃食管主动脉弓上吻合术式比较,术后反流性食管炎(GER)、吻合口并发症(吻合口瘘和狭窄)、残端阳性率有无差异。方法回顾性研究该科食管癌根治术病例,其中行右胸胸膜顶吻合术共159例,行左胸主动脉弓上吻合术133例。两组病人术后均进行24hpH值监测和胃食管钡餐造影检查,根据术后病检结果判断残端阳性率。结果两组病人术后残端阳性率的发生率为4.1%、10.9%,两组吻合口瘘及狭窄的发生率为2.5%、3.1%、6.8%及8.1%,右胸手术组病人明显减少(P<0.05);GER检测指标右胸手术组病人亦明显优于左胸手术组(P<0.05)。结论右胸膜顶吻合术式较左胸主动脉弓上吻合术式更能减少病人术后反流性食管炎、吻合口并发症,降低食道残端阳性率。

[Objiective] To study the difference in GER （Gastroesophageals Reflux）, positive of residium and complications of anastomosis, between fight thoracic suprathoracic anastomosis and left thoracic supra-aortic arch anastomosis in radical operation for esophageal cancer. [Methods] The clinical data of patients from January 1, 1998 to January 1, 2002 was analyzed retrospectively. Among them, 159 patients were received suprathoracic anastomosis and 133 patients were received supra-aortic arch anastomosis. 24 h PH in the esophagus was tested postoperatively and gastroesophageal barium meal photography. [Results] There is obviously differen in GER（P 〈0.05）, positive of residium（4.1%, 11.0%, P 〈0.05） and complications of anastomosis （2.5%, 3.1%, 6.8%, 8.1%, P 〈0.05 ）in two groups of patients. [Conclusions] The right thoracic operation can reduce GER, positive of residium and complications of anastomosis than the left thoracic operation