管状胃在食管、贲门癌手术中的临床应用

The Clinical Application Research of Gastric Tube in Surgeries to Treat Esophageal and Cardial Carcinoma

目的评价管状胃技术在食管、贲门癌患者根治手术中的临床效果。方法选取2008年1～10月瑞金医院胸外科收治的食管、贲门癌患者74例,按采取的手术方法不同分为管状胃组和胸腔胃组,管状胃组:46例,男36例,女10例;年龄59.67±9.96岁(36～77岁);食管癌31例,其中胸上段食管癌1例,胸中段食管癌23例,胸下段食管癌7例;贲门癌15例;采用左颈部吻合2例,主动脉弓上吻合19例,主动脉弓下吻合10例,贲门癌根治15例。胸腔胃组:28例,男25例,女3例;年龄59.17±11.33岁(37～86岁);食管癌22例,其中胸上段食管癌1例,胸中段食管癌17例,胸下段食管癌4例;贲门癌6例;采用左颈部吻合2例,主动脉弓上吻合17例,主动脉弓下吻合3例,贲门癌根治6例。观察两组患者手术后吻合口瘘发生率、手术时间、住院时间等临床指标。结果两组患者均顺利完成手术,管状胃组无吻合口瘘发生;胸腔胃组发生肺部感染并发症4例,死亡1例;管状胃组与胸腔胃组手术时间(180.00±10.34 min vs.185.00±6.23 min,t=1.669,P=0.078),术后住院时间(16.78±9.98 d vs.16.89±11.53 d,t=1.665,P=0.075)比较差异无统计学意义。结论管状胃在食管癌手术中并发症发生率较低,不增加手术时间和住院时间,可改善患者的生活质量,具有较好地临床应用价值。

Objective To Evaluate the clinical outcome of gastric tube in radical surgeries to treat esophageal and cardial carcinoma.Methods From January to October 2008,74 patients with esophageal or cardial carcinoma in Ruijin Hospital were enrolled in our study.Based on the surgical method,they were divided into the gastric tube group and the traditional way group.The gastric tube group had 46 patients,including 36 male patients and 10 female patients,whose age averaged 59.67±9.96 years（36 to 77 years）.Among them,31 patients had esophageal carcinoma with 1 upper,23 middle and 7 lower esophageal carcinoma,and 15 patients had cardial carcinoma.In this group,2 patients were treated with anastomosis in the left neck,19 with anastomosis in the upper aortic arch,10 with anastomosis in the lower aortic arch and 15 cardial carcinoma patients underwent radical resection.In the traditional way group,there were 28 patients,25 male patients and 3 female patients,whose age averaged 59.17±11.33 years（37 to 86 years）.In these patients,22 had esophageal carcinoma with 1 in the upper esophagus,17 in the middle esophagus,4 in the lower esophagus;and 6 patients had cardial carcinoma.In this group,2 patients were treated with anastomosis in the left neck,17 with anastomosis in the upper aortic arch,3 with anastomosis in the lower aortic arch,and 6 cardial carcinoma patients underwent radical resection.The rate of anastomotic leakage,operation time,and length of stay in hospital of these two groups were observed.Results All surgeries in the two groups were successfully performed.There was no anastomotic leakage case in the gastric tube group,while there were 4 pulmonary infection cases and 1 death case in the traditional way group.There was no statistically difference in the operation time（180.00±10.34 min vs.185.00±6.23 min,t= 1.669,P= 0.078） and length of stay in hospital（16.78±9.98 d vs.16.89±11.53 d,t=1.665,P= 0.075） between the gastric tube group and the traditional way group.Conclusion Gastric tube has a good value in clinical application with fewer complications and without prolonging operation and hospitalization time,which can surely better quality of life of the patients.