食管癌机械吻合手术方式的临床研究

Clinical investigation on surgical methods of esophageal cancer

目的研究食管圆锥形切割食管胃机械吻合与传统食管横断食管胃机械吻合两种不同手术方式对食管癌术后吻合口瘘和吻合口狭窄的影响。方法回顾性分析大连医科大学附属第二医院胸外科2010年5月至2013年4月采用食管圆锥形切割食管胃胸腔内机械吻合64例(研究组),随机选取同期传统食管横断食管胃胸腔内机械吻合64例(对照组),两组进行术后吻合口漏及吻合口狭窄等观察指标的对照研究。结果对照组发生吻合口瘘3例,吻合口狭窄6例;研究组无吻合口漏及吻合口狭窄。吻合口狭窄两组间差异有统计学意义(P<0.05)。结论研究组术式使吻合口黏膜对合整齐,避免了食管黏膜回缩的多种致瘘因素及有效预防吻合狭窄,明显优于对照组值得临床推广。

Objective To investigate the effects of anastomotic fistula and stenosis after surgery with the classical esophageal transaction and cone-cutting gastroesophageal mechanical anastomosis in esophageal cancers. Methods From May 2010 to April 2013, 128 esophageal cancer patients treated in our hospital were randomly divided into two groups, 64 cases（experimental group）with cone-cutting gastroesophageal mechanical anastomosis and 64 cases （control group）with the classify esophageal transaction gastroesophageal mechanical anastomosis. The surgical complications in two groups were compared including anastomotic fistula and stenosis. Results There were three cases with anastomotic fistula,six cases with anastomotic stenosis in the control group and none in the experimental group. And there were statistically significant between the two groups in anastomotic stenosis （P 〈 0.05）. Conclusion The surgical method in experimental group can effectively prevent stenosis because anastomosis mucosa fitting neatly can avoid many factors leading to anastomotic fistula and stenosis, such as esophageal mucosa retraction. It is significantly better than the control group and worthy of promotion.