食管、贲门癌切除食管胃吻合口并发症的回顾性分析

Retrospective Analysis of the Complications of Anastomosis after Resection of the Esophageal and Cardiac Carcinomas

目的 探讨食管胃吻合口并发症减少的真正原因。方法 １９８４ 年６ 月至１９９７ 年６ 月共手术切除食管癌和贲门癌５ １１９ 例，将前７ 年（１９８４ 年至１９９１ 年） 和后６ 年（１９９１ 年至１９９７ 年） 分为Ａ、Ｂ二组进行对比研究。结果 吻合口瘘、吻合口狭窄和返流性食管炎的发生率，Ａ组分别为４－２％ 、４－８６％ 和１５－５ ％ 。Ｂ组分别为１－０１ ％ 、２－１３％ 和７－０３％ 。Ａ 组吻合口瘘的死亡率为３９－３５ ％ ，Ｂ组无吻合口瘘死亡。二组并发症相比较有显著性差异（ Ｐ＜ ０．０１） 。Ａ、Ｂ二组的吻合方法我重要改变，只是吻合部位从胸腔上移至颈部。结论 吻合口并发症下降的原因是吻合技术的提高，与吻合方法关系不大。颈部吻合的最大优点是降低了吻合口瘘的死亡率。

Objective To find out the real cause of the reduction of the complications of the anastomosis.Method 5 119 patients with esophageal and cardiac carcinomas were treated surgically between June 1984 and June 1997.The pationts were divided into two groups(group A:1984～1991,group B:1991～1997) according to the perlod of operation and compared with each other.Result The incidences of anastomotic leakage,anastomotic stricture and esophageal reflux were 4.2%,4.86,and 15.5% respectively in group A,and 1.01%,2.13% and 7.03% respectively in group B The mortality of anastomotic leakage was 39.25% in group A and 0 in group B.There was significant difference between group A and group B( P<0.01) .The anastomotic technique in the two groups was not changed but the regions of anastomosis were different(group A in the thorax and group B in the neck respectively).Conclusion It was the improvement of the anastomotic technique,not the method of anastomosis,that reduced complications of anastomosis.The best advantage of cervical anastomosis was the reduction of the mortality of anastomosis leakage. [