梭形管状胃对食管癌微创手术下消化道重建效果影响

Effect of fusiform tube stomach on reconstruction of lower digestive tract in minimally invasive surgery for esophageal cancer

目的管状胃食管机械吻合是食管癌患者行胸腹腔镜联合手术中常用的吻合方式,但术后并发症发生率很高。本研究探讨食管癌患者微创手术下梭形管状胃消化道重建的临床效果。方法选择2017-03-01-2019-02-01林州市肿瘤医院(51例)与安阳市人民医院(45例)收治食管癌患者为研究对象。依据患者消化道重建的方式分为梭形管状胃组(50例)与细管状胃组(46例),对两组患者的术中情况、术后并发症、生存状况及术后生活质量分别进行比较与分析。结果梭形管状胃组患者术中闭合器的使用数量(t=2.221,P=0.031)及术中出血量(χ^2=4.952,P=0.029)均少于细管状胃组。梭形管状胃组术后患者纵隔管拔除时间为(10.6±1.2)d,短于细管状胃组的(19.1±1.3)d,t=2.465,P=0.014;梭形管状胃组术后住院时间为(12.8±1.4)d,短于细管状胃组的(21.7±1.5)d,t=2.314,P=0.021。梭形管状胃组患者术后瘘的发生率(χ^2=6.485,P=0.012)、肺部并发症Glavien-Dindo分级(χ^2=5.027,P=0.025)和低氧血症的发生率(χ^2=4.852,P=0.031)均低于细管状胃组。术后3个月,梭形管状胃患者的生活质量高于细管状胃组,P<0.05。结论梭形管状胃消化道重建不仅能明显提高食管癌微创手术患者的生活质量,还大大降低了术后患者的并发症。

OBJECTIVE Tubular gastroesophageal mechanical anastomosis is a common anastomotic method in patients with esophageal cancer undergoing thoracoscopic and laparoscopic surgery,but the incidence of postoperative complications is very high.The purpose of this study is to investigate the clinical effect of minimally invasive surgery in patients with esophageal cancer.METHODS From March 1,2017 to February 1,2019,51 patients with esophageal cancer in Linzhou Tumor Hospital and 45 patients in Anyang People’s Hospital were selected as the research objects.According to the way of digestive tract reconstruction,the patients were divided into spindle shaped stomach group(50 cases)and thin tube stomach group(46 cases).The intraoperative condition,postoperative complications,survival status and postoperative quality of life of the two groups were compared and analyzed.RESULTS The number of obturators used during operation(t=2.221,P=0.031)and intraoperative blood loss(χ^2=4.952,P=0.029)in the spindle shaped stomach group were significantly less than those in the thin tube stomach group.The number of obturators used during operation(t=2.221,P=0.031)and intraoperative blood loss(χ^2=4.952,P=0.029)in spindle shaped stomach group were significantly less than those in thin tube stomach group.The time to remove the mediastinal tube in the fusiform stomach group was(10.6±1.2)d,which was significantly shorter than(19.1±1.3)d in the tubulogastric group,t=2.465,P=0.014;The postoperative hospital stay in the fusiform stomach group was(12.8±1.4)d,which was significantly shorter than that in the small tube stomach group(21.7±1.5)d,t=2.314,P=0.021.The incidence of postoperative fistula(χ^2=6.485,P=0.012),Glavien-Dindo classification of pulmonary complications(χ^2=5.027,P=0.025)and incidence of hypoxemia(χ^2=4.852,P=0.031)in spindle shaped stomach group were significantly lower than those in small tube stomach group.Three months after operation,the quality of life of patients with spindle shaped stomach was significantly higher than that of patients with small tube stomach,P<0.05.CONCLUSION The results show that the reconstruction of fusiform stomach and digestive tract can not only significantly improve the quality of life of patients with esophageal cancer minimally invasive surgery,but also greatly reduce the postoperative complications.