管状胃在食管癌根治术中的临床应用效果评价

Clinical Curative Effect Appraisal of Tubular Stomach in Radical Surgery for Esophageal Carcinoma

目的探讨管状胃-食管残端吻合在食管癌根治术中的临床应用价值。方法回顾性分析2010年6月至2013年6月达州市中西医结合医院收治的377例行食管癌根治术后存活1年以上患者的临床资料,按照不同消化道重建方式分为管状胃组和全胃组,管状胃组191例,行管状胃-食管残端吻合,全胃组186例,行全胃-食管残端吻合,对两组患者术中、术后情况及生活质量进行综合比较。结果两组手术时间、术中出血量、术中淋巴结清扫数量、胸腔引流量及住院时间等比较差异无统计学意义(P>0.05);管状胃组术后肺部感染(5.76%)、胃排空不良(2.62%)、反流性食管炎(4.71%)的发生率显著低于全胃组(13.44%、8.60%、13.98%,P<0.05);管状胃组患者术后生活质量测评总得分(76.9±10.3)分及满意度(37.70%)均显著高于全胃组(65.4±9.8、20.43%,P<0.05),但管状胃组进食食物种类功能区、进食顺畅程度功能区得分低于全胃组(P<0.05)。结论管状胃-食管残端吻合用于食管癌根治术效果显著,可有效提高患者术后生活质量,并减少术后并发症的发生,值得临床推广应用。

Objective To investigate the clinical application value of tubular stomach-esophageal anas- tomosis in radical surgery for esophageal carcinoma. Methods Clinical data of 377 patients who underwent radical surgery for esophageal carcinoma with postoperative survival time ≥ 1 year in Dazhou City Hospital of Combined Traditional Chinese Medicine and Western Medicine from Jun. 2010 to Jun. 2013 were retrospectively analyzed, and they were divided into tubular stomach group （191 cases, tubular stomach-esophageal anastomosis）and full stomach group （186 eases, full stomach-esophageal anastomosis）, the intraoperative conditions, postoperative conditions and the quality of life of two groups were compared. Results There were no significant difference in operative time, blood loss, number of removed lymph nodes, chest drainage, hospitalization time between two groups（ P 〉 0. 05 ） ; the incidence of lung infection （ 5.76% ）, emptying dysfunction （2.62%）, reflux esophagitis （4.71% ） in tubular stomach group was lower than that of fuU stomach group （ 13.44 %, 8.60%, 13.98 % ） （ P 〈 0.05 ） ; the total score of life quality （ 76.9 ± 10.3 ） and satisfaction（37.70% ） in tubular stomach group were higher than that in full stomach group[ （65.4 ± 9.8 ）, 20.43%,P 〈 0.05 ], but the FD, SD scores of tubular stomach group were less than that of full stomach group（P 〈 0. 05 ）. Conclusion Tubular stomach-esophageal anastomosis has an good effect on radical surgery for esophageal carcinoma, which can effectively improve the life quality and reduce the occurrence of complication, which is worthy of clinical widely.