不同吻合方式对高龄患者食管次全切除术生存率的影响

Influence of Different Anastomoses for Elderly Patients on Survival Rate after Esophageal Subtotal Hysterectomy

目的探讨食管胃颈部吻合术和胸腔内吻合术对高龄食管癌患者食管次全切除术术后3年生存率的影响。方法选择2006年1月至2008年1月天门市第一人民医院收治的高龄食管癌患者92例为研究对象,按照吻合口部位的不同分为颈部吻合组(52例)和胸腔内吻合组(40例)。比较两组患者术后并发症和3年生存率的差异。结果颈部吻合组术后吻合口瘘、吻合口狭窄发生率及术后并发症总发生率分别为7.7%(4/52)、3.8%(2/52)、28.8%(15/52),均显著低于胸腔内吻合组的22.5%(9/40)、20.0%(8/40)、67.5%(24/40),差异有统计学意义(P<0.05或P<0.01)。颈部吻合组上切端癌残留率和总切端癌残留率分别为3.9%(2/52)、7.7%(4/52),均显著低于胸腔内吻合组的17.5%(7/40)、25.0%(10/40),差异有统计学意义(P<0.05)。颈部吻合组术后3年生存率高于胸腔内吻合组(69.2%比37.5%),差异有统计学意义(P<0.01)。结论高龄胸中下段食管癌患者食管次全切除术后应行食管胃颈部吻合术,可以减少术后并发症、提高患者远期生存率。

Objective To explore the influence of different anastomoses for elderly patients on 3-year survival rate after esophageal subtotal hysterectomy.Methods A total of 92 cases with esophageal cancer admitted to Tianmen First People′s Hospital from Jan.2006 to Jan.2008 were divided into cervical anastomo-sis group（n=52） and intrathoracic anastomosis group（n=40） according to the different anastomotic site. Postoperative complications and 3-year survival rate of the two groups were compared.Results Anastomotic leakage,anastomotic stenosis rate and the incidence of postoperative complications after operation of the cer-vical anastomosis group were 7.7%（4/52）,3.8%（2/52） and 28.8%（15/52）,which were lower than 22.5%（9/40）,20.0%（8/40） and 67.5%（24/40） of the intrathoracic anastomosis group,the differences were statistically significant（P〈0.05 or P〈0.01）.The upper cut end and both end tumor residual rate of cervical anastomosis group were 3.9%（2/52） and 7.7%（4/52）,which were lower than those of the intrathoracic anastomosis group[17.5%（7/40） and 25.0%（10/40）],the differences were statistically sig-nificant（ P 〈0.05 ） .3-year survival rate of the cervical anastomosis group was higher than that of the intrathoracic anastomosis group（69.2% vs 37.5%）,the difference was statistically significant（P〈0.01）. Conclusion Cervical esophagogastric anastomosis after esophageal subtotal hysterectomy for elderly patients with esophageal cancer should be performed to reduce postoperative complications and improve the long-term survival of patients.