不对称膈胃固定在食管癌手术弓上吻合中的应用

Application of asymmetric diaphragm gastric fixation in the arch anastomosis of esophageal cancer surgery

目的探讨不对称膈胃固定术对食管癌患者术后胃动力等的影响。方法本院胸心外科收治的食管癌患者200例,根据治疗方法不同分为A组、B组各100例。A、B两组患者均经左胸后外侧切口进胸,均使用吻合器吻合。A组采用传统的食管胃吻合、对称膈胃固定术,B组采用食管胃吻合、不对称膈胃固定术。观察2组患者术后并发症(胃排空障碍、反流性食管炎、胸胃综合征、吻合口瘘、吻合口狭窄)发生率。结果 A组胃排空障碍、胃反流性食管炎及胸胃综合征的发生率明显高于B组(P<0.05或P<0.01)。结论不对称膈胃固定术能有效地有利于胃的排空,降低了胸腔胃的张力,对减少患者术后胃排空障碍降低术后并发症、提高术后生活质量有极大的帮助。

Objective To explore the effects of asymmetric diaphragm gastric fixation on gastric motility of postoperative patients with esophageal cancer. Methods Two hundred patients with esophageal cancer received in department of cardiothoracic surgery of our hospital were divided into groups A and B according to different therapeutic methods, 100 cases in each group. The anas- tomat was inserted into the chest through left posterolateral incision in patients of two groups. Tra- ditional esophagogastric anastomosis and symmetrical diaphragm gastric fixation were used in group A, while esophagogastric anastomosis and asymmetric diaphragm gastric fixation in group B. Post- operative incidences of complications （delayed gastric emptying, reflux esophagitis, thoracic gastric syndrome, anastomotic leakage, anastomotic stricture） were observed in two groups. Results The incidences of delayed gastric emptying, reflux esophagitis and thoracic gastric syndrome in group A were significantly higher than those in group B （P〈0.05 or P〈0.01）. Conclusion Asymmetric diaphragm gastric fixation can effectively promote gastric emptying, reduce the gastric tension of thoracic cavity, decrease postoperative delayed postoperative quality of life. gastric emptying and complications, and improve