管状胃在食管癌切除术颈部吻合中的应用

Clinical Application of Tubular Stomach in Cervical Esophageal Reconstruction after Esophagectomy for Esophageal Cancer

目的探讨管状胃在食管癌切除术食管胃颈部吻合中的临床应用,总结其经验。方法将苏北人民医院2007年1月至2009年1月经"颈、胸、腹"三切口手术治疗食管癌患者850例,按手术先后分成A、B两组。A组行管状胃代食管手术,共425例,男287例,女138例;年龄(58.2±11.5)岁,其中食管上段癌27例,食管中段癌346例,食管下段癌52例。B组行全胃代食管手术,共425例,男298例,女127例;年龄(58.5±12.8)岁,其中食管上段癌33例,食管中段癌338例,食管下段癌54例。观察两组患者手术时间、住院时间以及术后吻合口瘘、吻合口狭窄、胸胃综合征、反流性食管炎等术后并发症的发生情况。结果全组患者均顺利完成手术,无死亡患者,A、B两组手术时间[(175.0±12.8)min vs.(171.0±10.5)min,t=1.702,P>0.05]和术后住院时间[(16.0±8.5)dvs.(16.3±8.8)d,t=1.773,P>0.05]差异均无统计学意义。术后随访6个月,无失访,A组吻合口瘘(χ2=5.550,P<0.05),反流性食管炎(χ2=9.150,P<0.05),胸胃综合征(χ2=10.500,P<0.05)等并发症发生率比B组低,且差异有统计学意义。两组吻合口狭窄发生率差异无统计学意义(χ2=0.120,P>0.05)。结论在经"颈、胸、腹"三切口治疗食管癌手术中,管状胃代食管更符合生理解剖要求,降低吻合口瘘、胸胃综合征及反流性食管炎等并发症发生率,改善患者术后生活质量。

Objective To investigate the clinical application of tubular stomach in cervical esophageal reconstruction after esophagectomy for esophageal cancer.Methods A total of 850 patients with esophageal cancer who underwent esophagectomy through cervico-thoraco-abdominal（3-field） approach between January 2007 and January 2009 in North Jiangsu Hospital were allocated into the tubular stomach group（group A,n=425） and the whole stomach group（group B,n=425）by operation order.Group A included 287 male and 138 female patients with their average age of 58.2±11.5 years.Among them,27 patients had upper esophageal cancer,346 patients had middle esophageal cancer and 52 patients had lower esophageal cancer.Group B included 298 male and 127 female patients with their average age of 58.5±12.8 years.Among them,33 patients had upper esophageal cancer,338 patients had middle esophageal cancer,and 54 patients had lower esophageal cancer.Operation time,postoperative length of hospital stay and the incidence of anastomotic leakage,anastomotic stricture,intra-thoracic stomach syndrome and reflux esophagitis of the two groups were compared. Results All the patients recovered uneventfully with no in-hospital death.There was no statistical difference in operation time（175.0±12.8 min vs.171.0±10.5 min,t=1.702,P0.05） and postoperative length of hospital stay（16.0±8.5 d vs.16.3±8.8 d,t=1.773,P0.05） between the two groups.During follow-up of six months,the rates of anastomotic leakage（χ2=5.550,P0.05）,intra-thoracic stomach syndrome（χ2=10.500,P0.05）and reflux esophagitis（χ2=9.150,P0.05） of group A were significantly lower than those of group B.There was no significant difference in the incidence of anastomotic stricture（χ2=0.120,P0.05） between the two groups.Conclusion Tubular stomach is better than whole stomach for cervical esophageal reconstruction after esophagectomy for esophageal cancer since it is more physiologically and anatomically complied.It can decrease the incidence of anastomotic leakage,intra-thoracic stomach syndrome,reflux esophagitis and improve the postoperative quality of life.