胸腹腔镜下胸内吻合+抗反流手术在食管鳞癌手术中的临床应用研究

Clinical application study of thoracic laparoscopic intrathoracic anastomosis+anti-reflux surgery in patients with esophageal squamous cell carcinoma

目的:观察T0-2期胸中下段食管鳞癌术中“改良棒球杆状管胃胸内吻合行上消化道重建+胃底包绕吻合口”的抗反流作用。方法:随机将100例食管鳞癌手术患者分为对照组和观察组各50例。观察组(棒球杆状管胃胸内吻合+抗反流组)制成胃底宽胃窦窄棒球杆状管胃行食管胃胸内端侧吻合,镜下将食管胃吻合口两侧胃组织分别缝合固定于吻合口上方食管侧壁,形成包绕吻合口180°至270°部分胃底折叠,加强术后抗返流的效果;对照组为传统微创治疗组(腔镜McKeown手术组)。观察和比较两组食管鳞癌手术患者在手术后的胃食管反流情况。结果:观察组患者手术后的胃食管反流发生率低于对照组,两组患者差异有统计学意义(P<0.05)。结论:食管癌手术中应用改良棒球杆状管胃食管胸内吻合+胃底部分包绕吻合口能降低胃食管反流发生,较好改善手术后患者生活质量。

Objective:To observe the anti-reflux effect of"improved baseball rod shaped intragastric anastomosis to reconstruct upper gastrointestinal+fundus pericardial anastomosis"in the middle and lower thoracic esophageal squamous cell carcinoma of T0-2 stage.Methods:100 patients with esophageal squamous cell carcinoma were randomly divided into control group and observation group(50 cases in each group).The observation group(baseball rod-shaped tube stomach and intrathoracic anastomosis+anti-reflux group)was made into a wide stomach sinus narrow baseball rod-shaped tube stomach esophagogastric thoracic end-to-side anastomosis,and the gastric tissue on both sides of the esophagus and stomach anastomosis They were sutured and fixed on the side wall of the esophagus above the anastomosis to form a partial fundoplication fold of 180°to 270°around the anastomosis to enhance the anti-reflux effect.The control group was the traditional minimally invasive treatment group(endoscopic McKeown operation group).Observed and compared the gastroesophageal reflux in the patients with esophageal squamous cell carcinoma after operation.Results:The incidence of gastroesophageal reflux in the observation group was lower than that in the control group.The difference between the two groups was statistically significant(P<0.05).Conclusions:The use of modified baseball rod-shaped gastroesophageal intrathoracic anastomosis and the fundus part of the anastomosis in the esophageal cancer surgery can reduce the occurrence of gastroesophageal reflux and improve the quality of life of patients after operation.