管状胃代食管在食管下段癌根治术消化道重建中的临床价值

The clinical value of tube stomach replacing esophagus in the reconstruction of digestive tract after radical resection of lower esophageal cancer

目的比较管状胃代食管与全胃代食管治疗食管下段癌的临床价值。方法选取2011年7月—2015年10月河北省人民医院胸外科收治的食管下段癌患者100例,均经左胸行食管癌根治术。按照随机数字表法分为管状胃组和全胃组,每组50例,管状胃组采用管状胃代食管手术重建,全胃组采用全胃代食管手术重建。分别比较2组围手术情况(包括手术时间、术中出血量、淋巴结清扫数、术后住院时间、手术费用)及术后并发症,以及术后1、3、6、12个月的肺功能变化及生活质量评价等。结果2组均无手术死亡病例。2组术中出血量、淋巴结清扫数、术后住院时间比较差异无统计学意义(P>0.05),而管状胃组手术时间、手术费用多于全胃组(t/P=2.814/0.006、6.030/0.000);管状胃组术后6个月、12个月生活质量评分明显优于全胃组(t/P=15.672/0.000、4.180/0.004),但2组术后1、3、6、12个月肺功能比较差异无统计学意义(P>0.05);2组术后并发症(包括吻合口瘘、胸胃综合征、心血管并发症、肺部并发症)比较,差异均无统计学意义(P均>0.05)。结论在食管下段癌治疗中,管状胃代食管比全胃代食管手术时间长且费用高,但管状胃代食管可明显改善术后患者生活质量。

Objective To compare the clinical value of tube stomach replacing esophagus and whole stomach replacing esophagus in the treatment of lower esophageal cancer.Methods From July 2011 to October 2015,100 patients with lower esophageal cancer admitted to thoracic surgery of Hebei Provincial People's Hospital were selected,all of whom underwent radical resection of esophageal cancer through the left chest.According to the random number table method,they were divided into two groups:the tubular stomach group and the whole stomach group.The whole stomach group was reconstructed by the operation of replacing esophagus with tube stomach.The perioperative conditions(including operation time,intraoperative blood loss,lymph node dissection,postoperative hospital stay and operation cost)and postoperative complications were compared between the two groups,as well as the pulmonary function changes and quality of life evaluation at 1,3,6 and 12 months after operation.Results There were no operative deaths in either group.There was no significant difference in intraoperative blood loss,lymph node dissection,and postoperative hospital stay between the two groups(P>0.05).However,the operation time and operation cost of the tubular stomach group were more than the total stomach group(t/P=2.814/0.006,6.030/0.000).The quality of life scores of the tubular stomach group at 6 months and 12 months were significantly better than those of the whole stomach group(t/P=15.672/0.000,4.180/0.044).However,there was no significant difference in lung function between the 2 groups at 1,3,6 and 12 months after operation(P>0.05).There were no significant differences in postoperative complications(including anastomotic leakage,chest and stomach syndrome,cardiovascular complications,pulmonary complications)in both groups(P>0.05).Conclusion In the treatment of lower esophageal cancer,the operation time and cost of tube stomach replacing esophagus is longer and higher than that of whole stomach replacing esophagus,but tube stomach replacing esophagus can significantly improve the quality of life of patients after operation.