食管癌切除食管胃端端分层吻合35例疗效分析

Analysis of 35 cases with end-to-end layered anastomosis in esophagogastrostomy after esophagectomy

目的探讨食管癌切除食管胃端端分层吻合的手术疗效。方法选择眉山市人民医院2016年1月至2017年2月接受食管癌切除食管胃端端分层吻合术的35例食管癌患者作为观察组(端端组),将同期接受食管癌切除食管胃端侧分层吻合术的21例食管癌患者作为对照组(端侧组)。比较2组患者手术吻合时间、吻合口的张力大小、受压迫程度及吻合口瘘发生率,比较反酸、嗳气及进食梗阻发生率。结果端端组平均吻合时间(25.17±5.15)min,端侧组平均吻合时间(26.10±5.30)min,2组比较差异无统计学意义(P>0.05)。端端组吻合口张力比端侧组小,且不受压迫而偏曲。端端组无吻合口瘘,端侧组有2例(9.52%)吻合口瘘,2组比较差异无统计学意义(P>0.05)。进流食端端组患者无梗阻感,端侧组4例(19.05%)出现梗阻感,2组比较差异有统计学意义(P=0.016)。围手术期及术后6个月内,反酸、嗳气发生率组间差异均无统计学意义(P>0.05)。术后6个月2组均无迟发吻合口瘘及需要扩张的吻合口狭窄。结论食管癌切除食管胃端端分层吻合因不需在管胃上另做切口,可避免管胃盲端挤压吻合口引起更多的不良反应。

Objective To evaluate the surgical efficacy of end-to-end layered anastomosis for patients with esophagogastrostomy after esophagectomy. Methods Selected 35 patients who received end-to-end layered anastomosis in esophagogastrostomy after esophagectomy in people＇s hospital of Meishan from January 2016 to February 2017 as end-to-end group,while 21 patients with end-to-side layered anastomosis in esophagogastrostomy after esophagectomy as end-to-side group. The anastomosis time,anastomosis tension,oppression degree,fistula incidence,acid reflux incidence,belching incidence and obstruction incidence between two groups were compared. Results The average anastomosis time was（ 25. 17 ± 5. 15） minutes in end-to-end group,and（ 26. 10 ± 5. 30） minutes in end-to-side group,the difference was not significant（ P〈0. 05）. The anastomosis tension of end-to-end group,without oppression,was mostly smaller than that of end-to-side group. There were no case of anastomotic fistula in end-to-end group and 2 cases（ 14. 29%） of anastomotic fistula in end-to-side group,the difference was not significant（ P〈0. 05）. There were no case of obstruction in end-to-end group and 4 cases（ 19. 05%） of obstruction in end-to-side group,the difference was significant（ P = 0. 016）. There was no significant difference in acid reflux and belching between the two groups（ P〈0. 05）in perioperative period and 6 months after surgery. There was no delayed anastomotic fistula and anastomotic stenosis needing expansion in6 months after surgery. Conclusion Without causing more adverse reactions,end-to-end layered anastomosis in esophagogastrostomy after esophagectomy can avoid the incision that may affect the blood supply of esophagus and stomach,and avoid the pressure from esophagus and stomach.