管状胃和膈肌缝合预防食管癌切除术后胃排空障碍的效果分析

Effect analysis of tubular stomach-diaphragm suture in preventing delayed gastric emptying after esophagectomy

目的总结管状胃和膈肌缝合固定在预防经颈、胸、腹三切15食管癌切除术后胃排空障碍中的应用经验。方法回顾性分析我科2009年6月至2013年7月980例经颈、胸、腹三切口手术治疗食管癌患者，均行管状胃代食管手术。将患者分为两组：A组530例，未作特殊处理，其中食管上段癌63例，食管中段癌382例，食管下段癌85例；B组450例，将胃缝合固定于膈肌，其中食管上段癌43例，食管中段癌343例，食管下段癌64例。比较两组患者术后胃排空障碍的发生情况。结果A组患者均顺利完成手术，无患者死亡。B组与A组相比较，其术后胃排空障碍的发生率显著减少（P〈0．05）。结论在经颈、胸、腹三切口治疗食管癌手术中，通过将管状胃与膈肌缝合固定可以降低经颈、胸、腹三切口食管癌切除术后胃排空障碍的发生率。

Objective To summarize the experience of tubular stomach-diaphragm suture in preventing delayed gastric emptying after esophagectomy through eervico-thoraco-abdominal approach. Method A total of 980 patients with esophageal cancer who underwent esophageetomy through cervico-thoraco- abdominal from June 2009 to July 2013 were retrospectively recruited. All patients underwent the tubular stomach reconstruction and divided into group A（ n = 530）and B （n = 450）. In group A, there were 387 males and 143 females,with an average age of（59.2 ± 10.5）years. There were 63 cases of upper esophageal cancer,382 cases of middle esophageal cancer,and 85 cases of lower esophageal cancer. No special management was performed in this group. In group B,there were 328 males and 122 females,with an average age of（58.9 ±11.3） years. There were 43 cases of upper esophageal cancer,343 cases of middle esophageal cancer and 64 cases of lower esophageal cancer. The stomach was sewed to the diaphragm in this group. Incidence of delayed gastric emptying was compared between groups. Result All patients were uneventfully recovered with no operative death. The incidence of delayed gastric emptying in group B was significantly lower than that in group A（P 〈 0.05）. Conclusion Tubular stomach-diaphragm suture can decrease the incidence of delayed gastric emptying after esophagectomy through cervico-thoraco-abdominal approach.