食管胃颈部吻合与胃胸腔内吻合在中下段食管癌患者右胸入路根治术中的应用比较

Application and Comparison of Cervical Esophagogastric Anastomosis and Gastric Intrathoracic Anastomosis in Right Thoracic Radical Resection of Patients with Middle and Lower Section of Esophageal Cancer

目的研究食管胃颈部吻合与胃胸腔内吻合在中下段食管癌患者右胸入路根治术中的应用效果。方法选择73例患者作为研究对象,采用双盲法将其分为对照组(n=36)和观察组(n=37)。2组患者均进行右胸入路根治术,对照组实施胃胸腔内吻合,观察组实施食管胃颈部吻合。观察2组手术相关指标、术后并发症发生情况、术后3个月生活质量[简明健康生活状况量(SF-36)]以及3年生存率。结果2组手术用时、术中出血量、淋巴结清扫数量相比,差异无统计学意义(P>0.05);观察组术后放管时间、住院天数短于对照组,食管切除长度长于对照组,切端癌残留率低于对照组,差异有统计学意义(P<0.05)。观察组并发症发生率低于对照组,但差异无统计学意义(P>0.05);术后3个月,2组SF-36各维度评分比术前高,且观察组高于对照组(P<0.05)。观察组术后1年生存率高于对照组,但差异无统计学意义(P>0.05);术后3年生存率高于对照组,差异有统计学意义(P<0.05)。结论中下段食管癌患者右胸入路根治术中应用食管胃颈部吻合,可扩大切除范围,降低切端癌残留率,利于术后恢复,并可有效提高术后生活质量和近期生存率。

Objective To study the application effect of cervical esophagogastric anastomosis and gastric intrathoracic anastomosis in patients with middle and lower section of esophageal cancer through right thoracic approach radical resection radical resectiony.Methods 73 patients were selected as the research objects.According to the double-blind method,they were divided into the control group(n=36)and the observation group(n=37).All patients received radical mastectomy through the right thoracic approach radical resection,the control group underwent gastric intrathoracic anastomosis,and the observation group underwent cervical esophagogastric anastomosis.Observed the surgery-related indicators,the occurrence of postoperative complications,the quality of life 3 months after operation[Concise healthy living conditions(SF-36)]and the three-year survival rate of the 2 groups.Results Compared with the operation time,intraoperative blood loss,and the number of lymph nodes dissection in the 2 groups,there was no statistical significant difference(P>0.05);the postoperative tube release time and hospital stay of the observation group were shorter than those of the control group,the length of esophagectomy was longer than that of the control group,and the residual rate of resection cancer was lower than that of the control group,with a statistical significant difference(P<0.05).The incidence of complications in the observation group was lower than that in the control group,but there was no statistical significant difference(P>0.05);3 months after operation,the scores of SF-36 dimensions of the 2 groups were higher than those before the operation,and the observation group was higher than the control group(P<0.05);the 1-year survival rate of the observation group was higher than that of the control group,but there was no statistical significant difference(P>0.05);the 3-year survival rate after surgery was higher than that of the control group,and with a statistical significant difference(P<0.05).Conclusion The application of cervical esophagogastric anastomosis in patients with middle and lower section of esophageal cancer through right thoracic approach radical resection can expand the scope of resection and reduce the residual rate of resection end cancer,which is more conducive to postoperative recovery and can effectively improve postoperative quality of life and short-term survival rate.