食管空肠两层半吻合在高龄食管胃结合部癌高位吻合中应用研究

Double and a half layered anastomosis method for high esophagojejunal anastomosis in elderly patients with gastric cancer

目的探讨食管空肠两层半吻合法在高龄食管胃结合部癌高位吻合中的应用价值。方法回顾性分析2014年3月至2019年5月郑州大学附属肿瘤医院行根治性全胃切除术的160例高龄(≥70岁)食管胃结合部癌(SiewertⅡ型)病人临床资料。75例采用两层半吻合法进行食管空肠吻合者为观察组,85例采用常规方法吻合者为对照组。统计两组手术时间、术中吻合口加固时间、术后并发症种类及例数,术后ICU入住率及术后住院时间。结果所有病人均顺利完成手术,无围手术期死亡病例。两组在手术时间、吻合口加固时间及肿瘤近端切缘方面差异无统计学意义(P均>0.05)。两组术后吻合口相关并发症发生率[观察组4.0%(3/75)vs.对照组12.9%(11/85)]比较差异有统计学意义(χ^2=3.989,P<0.05)。两组术后非吻合口相关并发症:观察组共11例,术后ICU入住率12.0%(9/75),术后住院时间17(12~36)d;对照组共16例,术后ICU入住率14.1%(12/85),术后住院时间19(11~41)d,两组比较差异均无统计学意义(χ^2=2.000,0.081,Z=-0.655,P>0.05)。结论食管空肠两层半吻合作为一种安全、简单的吻合方法能够降低术后吻合口并发症发生率,适用于高龄食管胃结合部癌行高位吻合病人。

Objective To investigate the effect of double and a half layered anastomosis method for high esophagojejunal anastomosis in elderly patients with gastric cancer.Methods The clinical data of 160 elderly patients(≥ 70 years old)who performed radical gastrectomy in Affiliated Tumor Hospital of Zhengzhou University(Henan Tumor Hospital) between March 2014 and May 2019 were analyzed retrospectively.Double and a half layered anastomosis method was used in observation group(n=75),the routine anastomosis was used in the control group(n=85).Data analysis included operating time,anastomosis time,types and cases of postoperative complications,postoperative ICU occupancy rate and postoperative hospitalization time.Results All patients successfully completed the operation,and there were no perioperative deaths.There was no significant difference between the two groups in operation time,anastomosis time and near cutting margin.Postoperative situations:The incidence of anastomotic complications was 4.0% in the observation group and 12.9% in the control group,with a statistically significant difference between two groups(χ^2=3.989,P <0.05).There were 11 cases of non-anastomotic complications in the observation group,16 cases in control group.In observation group,postoperative ICU occupancy rate was 12.0%(9/75) and postoperative hospitalization time was 17(12-36) days,while in control group they were 14.1%(12/85) and 19(11-41) days.There were no statistically significant differences between two groups(χ^2=2.000,0.081,Z=-0.655,P>0.05).Conclusion As a safe and simple anastomotic method,the double and a half layered anastomosis method can reduce anastomotic complications,applicable for high esophagojejunal anastomosis in elderly patients.