比较食管癌僧帽状浆肌瓣包埋手工吻合法与机械吻合法的手术效果

Comparison of Manual Sacral Musculocutaneous Flap Anastomosis and Mechanical Anastomosis for Esophageal Cancer

目的观察食管癌外科手术中僧帽状浆肌瓣包埋手工吻合对降低术后并发症发生率的效果,探讨食管癌患者外科手术最佳吻合术式。方法选取2017年7月至2018年2月收治的200例食管癌患者,按吻合方法的不同分为2组:机械吻合组(行机械吻合,n=103),手工吻合组(行僧帽状浆肌瓣包埋手工吻合,n=97)。比较2组术中、术后的相关指标。结果 2组手术时间、术中出血量、术后禁食时间、住院时间,术后吻合口瘘、呼吸系统并发症、胃排空延迟、胸腹腔感染发生率比较,差异均无统计学意义(P>0.05);手工吻合组较机械吻合组住院费用[(40 422.8±2 574.7)元比(43 532.2±5 470.7)元]、术后吻合口狭窄(4.9%比13.4%)、反流性食管炎发生率(3.9%比11.3%)比较,差异有统计学意义(P<0.05)。结论对比传统的机械吻合,行僧帽状浆肌瓣包埋手工吻合手术的食管癌患者住院费用更少、术后吻合口狭窄、反流性食管炎发生率更低。

Objective To observe the efficacy of manual anastomosis of sacral musculocutaneous flap for reducing postoperative complications in esophageal cancer,and to explore the optimal anastomosis procedure for esophageal cancer. Methods A total of 200 patients with esophageal cancer admitted from July 2017 to February 2018 were divided into two groups： mechanical anastomosis group（ n =103） and manual anastomosis group（manual sacral musculocutaneous flap anastomosis, n =97）.Intraoperative and postoperative relevant indexes were compared between the two groups. Results There were no significant differences in operation time,intraoperative blood loss,postoperative fasting time,hospital stay,postoperative anastomotic leakage,respiratory complications,delayed gastric emptying and incidence of thoracic and abdominal infection between the two groups（ P 〉0.05）.Compared with mechanical anastomosis group,hospitalization costs and incidences of postoperative anastomotic stenosis and reflux esophagitis markedly decreased in manual anastomosis group（（40 422.8±2 574.7） yuan vs（43 532.2±5 470.7） yuan,4.9% vs 13.4% and 3.9% vs 11.3%,respectively; P 〈0.05）. Conclusion Manual sacral musculocutaneous flap anastomosis is superior to traditional mechanical anastomosis for reducing hospitalization costs and incidences of postoperative anastomotic stenosis and reflux esophagitis.