套入式包埋吻合在食管癌/贲门癌手术治疗中应用价值的病例对照研究

Application of Telescopic Embedding Anastomosis in Surgical Treatment of Esophageal and Cardiac Carcinoma:A Case Control Study

目的 探究改良套入式包埋吻合在食管癌、贲门癌根治术中的应用和效果。方法 回顾性分析2014年1月至2015年5月郑州大学第一附属医院胸外一科同一治疗组食管癌、贲门癌根治手术治疗的160例患者的临床资料。其中男119例、女41例,年龄（61.6±7.1）岁。64例采用Sweet术式,96例采用胸腹腔镜McKeown术式,均行食管-管状胃机械吻合。患者根据包埋方式分为改良组和传统组。改良组46例,男34例、女12例,年龄（61.7±6.4）岁,采用改良套入包埋吻合口;传统组114例,男85例、女29例,年龄（62.2±7.5）岁,采用传统间断水平褥式包埋吻合口。对比观察两种包埋吻合口方式的术后恢复情况。结果 与传统组相比,改良组吻合口瘘发生率明显降低（0.0%vs.12.3%,χ~2=4.478,P=0.013）,吻合时间明显缩短[（28.9±2.9）min vs.（30.0±3.1）min,t=-1.983,P=0.049],但吻合口狭窄发生率更高（30.4%vs.3.5%,χ~2=23.799,P=0.000）。两组肺部并发症、心血管并发症、喉返神经损伤、围术期死亡率差异无统计学意义（P〉0.05）。结论 改良套入式包埋吻合在食管癌、贲门癌根治术中安全可行,能够有效降低吻合口瘘发生率。

Objective To explore the effects of modified telescopic embedding anastomosis in surgical treatment of esophageal and cardiac carcinoma. Methods We retrospectively analyzed the clinical data of 160 patients with esopha- geal or cardiac cancer undergoing surgery in our group from January 2014 through May 2015. There were 119 males and 41 females with a mean age of 61.6±7.1 years. Sixty-four patients received Sweet esophagectomy and 96 patients underwent minimally invasive Mckeown esophagectomy, and all the patients received end to side mechanical anastomosis. The patients were divided into a modified group and a traditional group according to the embedding types. There were 34 males and 12 females aged 61.7±6.4 years in the modified group undergoing modified telescopic embedding. There were 85 males and 29 females aged 62.2±7.5 years in the traditional group undergoing traditional interrupted horizontal mattress suture embedding. The anastomostic time and postoperative complications were compared between the two groups. Results Compared with the traditional group, obviously lower incidence of anastomotic fistula （0.0% vs. 12.3%, x^2=4.478, P=0.013）, shorter anastomosis time （28.9±2.9 min vs. 30.0±3.1 min, t=-1.983, P=0.049）, but a higher incidence of anastomotic stenosis （30.4% vs. 3.5%,x^2=23.799, P=0.000） in the modified group were found. There were no significant differences in the incidences of pulmonary complications, cardiovascular complications, laryngeal recurrent nerve injury, or perioperative mortality between the two groups （P〉0.05）. Condusion Modified telescopic embedding anastomosis is safe and feasible in surgical treatment of esophageal and cardiac carcinoma, and can effectively reduce the incidence of anastomotic fistula.