食管胃颈部T型全机械侧侧吻合在全腔镜食管癌治疗中的应用

Technique of cervical esophagogastric side-to-side stapled anastomosis in minimally invasive esophagectomy

目的探讨食管胃颈部T型全机械侧侧吻合在全腔镜食管癌根治术中的应用价值。方法回顾性分析2014年3月至2015年3月行全腔镜食管癌根治+食管胃左颈部吻合术110例患者的临床资料,其中以颈部管状吻合器吻合的65例患者为对照组,颈部T型全机械侧侧吻合的45例患者为观察组。比较两组术中吻合时间,术后吻合口瘘,术后6个月吻合口狭窄、胃食管反流情况的差异。结果所有手术均在全腔镜下完成,无围手术期死亡病例。观察组的吻合时间为(16.1±2.5)min,显著低于对照组的(27.5±1.9)min(P=0.000)。观察组的术后吻合口瘘发生率、术后6个月胃食管反流发生率与对照组比较,差异无统计学意义(P>0.05)。观察组的术后6个月吻合口狭窄的发生率(4.4%)显著低于对照组(24.6%),差异有统计学意义(P=0.005)。结论食管胃颈部T型侧侧吻合能缩短术中吻合时间,降低术后6个月吻合口狭窄的发生率,同时不增加吻合口瘘和术后6个月食管胃反流的发生率,是一种值得推广的颈部吻合方式。

Objective To evaluate the efficacy of cervical esophagogastric side-to-side stapled anastomosis in minimally inva- sive resection of esophageal carcinoma. Methods We retrospectively analyzed the clinical data of 110 patients with esophageal carcinoma underwent completely minimally invasive esophagectomy and left cervical esophagogastromy from March 2014 to March 2015. Six- ty-five patients underwent cervical esophagogastromy using circular stapler as control group, and the rest 45 patients were treated by cervical esophagogastric side-to-side stapled anastomosis as experimental group. The anastomosis time, postoperative anastomotic leakage, anastomotic stricture and gastroesophageal reflux were compared between the two groups. Results All the patients underwent minimally invasive resection, and no death happened during perioperative period. The time of anastomosis in experiment group was （ 16. 1±2. 5 ） min, shorter than （27.5±1.9） min of control group （P = 0. 000）. The incidence of anastomotic leakage and gastroesopha- geal reflux 6 months after operation had no significant difference （P〉0. 05 ）. The incidence of anastomotic stricture 6 months after opera- tion in experimental group was 4. 4%, lower than 24. 6% of control group（P = 0. 005）. Conclusion The technique of cervical esopha- gogastric side-to-side stapled anastomosis can shorten the anastomosis time and reduce the incidence of anastomotic stricture 6 months after operation, and have no tendency to increase anastomotic leakage and gastroesophageal reflux 6 months after operation. It is a satis- factory technique for the treatment of esophageal carcinoma.