食管胃端端器械吻合与常规食管胃端侧器械吻合在食管胃交界部癌根治术中的临床疗效比较

Comparison of Clinical Efficacy of Esophagogastric End-to-End Mechanical Anastomosis and Regular Esophagogastric End-to-Side Mechanical Anastomosis in Radical Surgery of Adenocarcinoma of Esophagogastric Junction

目的研究食管胃端端器械吻合与常规食管胃端侧器械吻合在食管胃交界部癌根治术中对吻合口并发症以及术后胃瘫的影响,并统计患者1年内的生存情况。方法选取2013年6月至2017年3月在宁阳县第一人民医院诊断为食管胃交界部癌的162例患者为研究对象,其中77例采用食管胃端侧器械吻合的患者定义为常规组; 85例采用食管胃端端器械吻合的患者定义为改良组。比较两组患者吻合口并发症的发生率、术后胃瘫的发生率以及1年生存情况。结果改良组术后吻合口瘘、吻合口狭窄的发生率均明显低于常规组[1. 2%(1/85)比10. 4%(8/77)、0%比7. 8%(6/77)](P <0. 05),而两组术后吻合口炎、术后胃瘫的发生率比较差异无统计学意义(P> 0. 05);两组随访1年内均无死亡病例。结论食管胃交界部癌切除后食管残胃的端端器械吻合,可有效减少吻合口瘘、吻合口狭窄的发生。同时因食管残胃的顺应性较好,有利于胃的排空,可有效减少胃瘫的发生,从而提高患者生活质量。

Objective To study the influence of esophagogastric end- to-end mechanical anastomosis and regular esophagogastric end-to- side mechanical anastomosis on incidence of anastomotic complications and postoperative gastric paralysis in the radical surgery of adenocarcinoma of esophagogastric junction,and record the1-year survival. Methods A total of162 cases of adenocarcinoma of the esophagogastric junction were selected in the First People′ s Hospital of Ningyang County from Jun.2013 to Mar.2017.Among them,77 cases treated with esophagogastric end-to-side mechanical anatomosis were defined as regular group,85 cases treated with esophagogastric end-to-end mechanical anastomosis were defined as a modified group.The incidences of complications of anastomotic opening,postoperative gastric paralysis and1-year survival situation of the two groups were compared. Results The incidence of postoperative anastomotic fistula and anastomotic stenosis in the modified group were significantly lower than that in the regular group[1.2%(1/85) vs10.4%(8/77),0% vs 7.8 %(6/77)]( P <0.05);there was no significant difference in the incidence of postoperative anastomotic inflammation and postoperative gastroparesis between the two groups( P >0.05);no deaths occurred in the two groups within1 year of follow-up. Conclusion Esophagogastric end-to-end mechanical anastomosis can reduce the tension of anastomotic stoma,prevent anastomotic fistula and anastomotic stenosis.At the same time the esophagus remnant stomach ′s compliance is good,which is good for stomach emptying and can effectively reduce the occurrence of gastric paralysis,thereby improves the patient life quality.