管状胃与次全胃代食管颈部吻合术在食管癌根治术中的比较观察

The effect analysis of tubular and subtotal gastroesophageal cervical anastomosis in radical surgery for esophageal carcinoma

目的比较管状胃与次全胃代食管颈部吻合术在食管癌根治术中的血清学标志物、并发症等差异。方法前瞻性将2014年5月至2017年6月食管癌患者90例随机分为两组,A组50例,B组40例,术前均行2周的辅助化疗,化疗1个月后择期行手术,A组进行管状胃代食管颈部吻合术,B组进行全胃代食管颈部吻合术。观察两组手术时间、出血量、下床活动时间以及血清学指标(测定患者血清肿瘤标志物含量、肿瘤恶性生物学标志物含量、Survivin蛋白含量),并比较两组术后并发症情况。结果两组平均手术时间、术中出血量、术后下床活动时间差异均无显著性(P>0. 05)。术后1周两组血清可溶型MHC-Ⅰ类链相关蛋白A(sMICA)和转录因子YYl(YYl)、基质金属蛋白酶-9(MMP-9)和血管内皮生长因子(VEGF)、Survivin蛋白含量均明显低于术前,差异具有显著性(P <0. 05)。两组术前和术后sMICA、YYl、MMP-9、VEGF、Survivin蛋白含量差异均无统计学意义(P> 0. 05)。A组术后并发症发生率为34. 0%,明显高于B组(7. 5%),差异具有显著性(P <0. 05)。A组主要并发症为吻合口瘘和吻合口狭窄。结论次全胃代食管颈部吻合术在食管癌根治术中出现的并发症较管状胃代食管颈部吻合术少,相对安全,两者均可下调血清学肿瘤相关因子及Survivin蛋白表达,且差异无显著性。

Objective To compare the effect of tubular and subtotal gastroesophageal cervical anastomosis in radical surgery for esophageal carcinoma. Methods From May 2014 to June 2017, 90 cases of esophageal cancer patients were randomly divided into two groups, 50 cases in group A, B group with 40 cases. Preoperatively 2 weeks of adjuvant chemotherapy, 1 month of chemotherapy before selective surgery were performed, A group with gastroesophageal cervical anastomosis, B group with subtotal gastroesophageal cervical anastomosis. The operation time, blood loss, ambulation time, serological examination： determination of content of serum tumor markers, tumor patients with malignant biological markers content, Survivin protein content were Observed. And the postoperative complications of the two groups were compared. Results The average operation time, intraoperative blood loss, postoperative bed activity time differences were not significant （ P 〉 0.05）. After one week, serum sMICA and YY1, MMP-9 and VEGF, Survivin protein content in the two groups were significantly lower than the preoperative, statistically significant difference （ P 〈0.05）. Two groups of preoperative and postoperative sMICA, YY1, MMP - 9, VEGF and Survivin protein content differences had no statistical significance （ P 〉 0.05 ）. The incidence of postoperative complications in A group was 34.0% , significantly higher than that of group B （7.5%） , with significant difference （ P 〈 0.05）. The main complications of A group were anastomotic fistula and anastomotic stenosis. Conclusion In esophageal cancer radical, a full stomach generation of cervical esophagus anastomosis than tubular generation of cervical esophagus anastomosis fewer complications, relatively safe, two methods of operation can be cut serological tumor related factor and Survivin protein expression, but there was no significant difference.