吻合口加固缝合对食管癌根治术后吻合口瘘发生的预防效果

Effect of reinforcement suture of anastomotic stoma during radical resection of esophageal carcinoma in prevention of postoperative anastomotic leakage

目的探讨吻合口加固缝合对食管癌根治术后吻合口瘘的预防作用。方法入组2016年1月至2018年12月期间在北京大学肿瘤医院胸外二科接受食管癌根治术的患者193例,分为吻合口加固缝合组(70例)及不加固缝合组(对照组,123例)。对照组采用常规颈部机械吻合,加固缝合组在颈部机械吻合基础上,采用“8”字横行褥式包埋缝合吻合口四周。记录吻合口瘘在2组患者中的发生情况。采用多因素Logistic回归方法分析术后吻合口漏的相关独立影响因素。结果食管癌根治术后,吻合口瘘在吻合口加固缝合组中的发生率明显低于对照组,差异有统计学意义(5.7%vs 17.9%,P=0.017)。术后2年随访期间,2组均未发现吻合口狭窄以及死亡病例。多因素Logistic回归分析显示,加固缝合是吻合口瘘的独立保护因素(OR=0.291,95%CI:0.096~0.887,P=0.030)。结论吻合口加固缝合可有效减少食管癌根治术后发生吻合口瘘的风险。

Objective To evaluate the preventive effects of reinforcement suture of anastomotic stoma during radical resection of esophageal carcinoma on postoperative anastomotic leakage.Methods A total of 193 patients who underwent radical resection of esophageal carcinoma were collected at the Department of Thoracic Surgery II of Beijing Cancer Hospital between January 2016 and December 2018.They were divided into either a reinforcement suture group(70 cases)or a non-reinforcement suture group(control group,123 cases).Esophagogastric anastomosis was performed by neck mechanical anastomosis in the control group.Reinforcement suture of anastomotic stoma was performed by transverse mattress suture in a figure-of-eight in the reinforcement suture group.After the surgery,the incidence of anastomotic leakage was recorded in the two groups.Multiple Logistic regression analysis was used to identify the independent risk factors for anastomotic leakage.Results After radical resection of esophageal carcinoma,the incidence of anastomotic leakage was significantly lower in the reinforcement suture group than in the control group(5.7%vs 17.9%,P=0.017).There was no anastomotic stoma stenosis or death in either group during 2 years of follow-up.Multiple Logistic regression analysis showed that reinforcement suture was an independent protective factor for anastomotic leakage(OR=0.291,95%CI:0.096-0.887,P=0.030).Conclusion Reinforcement suture of anastomotic stoma during radical resection of esophageal carcinoma is effective in reducing the risk of postoperative anastomotic leakage.