老年食管癌病人微创手术中不同胸腔内吻合方法的比较

Comparison of two kinds of intrathoracic anastomosis in minimally invasive surgery for elderly patients with esophageal cancer

目的比较老年食管癌病人经右胸微创、腹正中切口食管癌根治术中分别采用倒穿刺法和常规法进行胸腔内吻合的可行性、安全性及优劣势。方法回顾性分析2017年1月至2020年1月42例60岁以上经右胸微创、腹正中两切口食管癌手术病人的临床资料。根据胸部吻合方法的不同将42例病人分为A、B两组,每组各21例。A组采用倒穿刺法完成吻合,B组采用常规法完成吻合。比较2组手术吻合时间、吻合部位、术中出血量、术后吻合口并发症、术后住院天数等资料。结果A组病人中共17例顺利完成手术,4例病人因各种原因中转手术;B组病人均顺利完成。2组病人性别、年龄等一般资料无明显差异(P>0.05)。2组吻合时间、吻合部位差异有统计学意义(P<0.05),术中出血量、术后吻合口并发症发生率以及住院天数比较,差异无统计学意义(P>0.05)。结论倒穿刺法操作相对简单,但操作稳定性差,常规法操作相对复杂,但吻合成功率高,2种方法均可用于食管癌微创手术。

Objective To compare the feasibility and safety of inverted puncture and conventional intrathoracic anastomosis in esophagectomy in the elderly patients with esophageal cancer.Methods A retrospective study was conducted including 42 patients aged over 60 years old with esophageal cancer from January 2017 to January 2020.According to the different methods of thoracic anastomosis,42 patients were divided into group A and group B with 21 case in each group.Group A was anastomosed by inverted puncture.Group B received routine anastomosis.The general data of patients before operation were collected,and the data of anastomotic time,anastomotic site,intraoperative bleeding,postoperative anastomotic complications and postoperative hospital stay were compared between the two groups.Results A total of 17 patients in group A successfully completed the operation.Four patients were transferred to surgery for various reasons.All the patients in group B completed smoothly.There were no significant differences in general data of sex and age between the two groups(P>0.05).The anastomosis time was lower,and anastomotic site was higher in group A than those in group B(P<0.05).There were no significant differences in the volume of intraoperative hemorrhage,postoperative hospitalization days and complications between the two groups(P>0.05).Conclusions Both inverted puncture and conventional thoracic anastomosis are feasible and safe.