常规吻合与双荷包吻合对食管癌术后吻合口狭窄的对比分析

Comparison of incidence rate of anastomotic stricture between conventional anastomosis and double-layers anastomosis after operation of esophageal cancer

目的探讨改进吻合方式以减少吻合口狭窄的方法，为降低食管癌术后吻合口狭窄发生率提供帮助。方法收集2013年4月到2015年8月在我院接受左开胸食管癌根治术的老年食管癌患者（平均年龄〉60岁）374例，其中双荷包吻合组：器械吻合时分别在食管、胃壁行双荷包吻合187例；常规吻合组：器械吻合时不给予胃壁荷包缝合187例，对比观察两组术后吻合口狭窄发生情况。结果术后双荷包吻合组发生轻度狭窄7例（3．7％），常规吻合组17例（9．1％）（x2=4．452，P=0．035），中度狭窄4例（2．1％）比12例（6．4％）（x2=4．179，P=0．041），重度狭窄3例（1．6％）比9例（4．8％）（x2=3．099，P=0．078），总狭窄例数38例比14例，两组比较差异有统计学意义（x2=12．866，P=0．000），双荷包吻合组相对优于常规吻合组。结论双荷包吻合法能够更有效减少术后吻合口狭窄的发生率。

Objective To explore how to decrease the incidence of anastomotic stricture after the operation of esophageal cancer by improving anastomosis. Methods Clinical data of 374 cases aged 〉60 years who had undergone left thoracotomy radical resection of esophagus cancer at our hospital from April 2013 to August 2015 were collected. Patients were divided into double-layers anastomosis group （n= 187） and conventional anastomosis group （n= 187）. During process of stapling anastomosis, double purse string anastomosis on esophagus and gastric wall were performed in double-layers anastomosis group, with no purse string suture in conventional anastomosis group. Incidence rate of anastomotic stricture was compared between the two groups. Results Conventional anastomosis group versus double-layers anastomosis group showed that a mild anastomotic stricture occurred in 17 cases（9,1%）versus 7 cases（3.7%） （X2= 4. 452,P = 0. 035）, a moderate anastomotic stricture in 12 cases（6.4%）vs. 4 cases（2.1%）（X2=4.179,P=0.041）,a severe anastomotic stricture in 9 cases （4.8%）vs. 3 cases（1.6Yo）（X2=3. 099,P=0. 078） ,total number of anastomotic stricture in 38 cases vs. 14 cases （X2= 12. 866 ,P=0. 000）,showing that double-layers anastomosis was relatively superior to conventional anastomosis. Conclusions Double-layers anastomosis can effectively reduce the incidence of anastomotic stricture after surgery.