不同吻合方式在食管胃吻合术中的应用比较

Comparison of different anastomosis methods in esophagogastric anastomosis

目的比较全层手工吻合、分层手工吻合、机械管状吻合和三角吻合在食管胃吻合术中的应用效果。方法选取2015年1月至2020年11月武汉市第一医院收治的314例食管癌手术患者作为研究对象,根据吻合方式的不同,将患者分为全层手工吻合组(n=67)、分层手工吻合组(n=79)、机械管状吻合组(n=88)和三角吻合组(n=80)。比较4组患者颈部吻合时间、整个手术时间、术后吻合口瘘发生率、吻合口狭窄发生率以及术后胃食管返流情况。结果全层手工吻合组和分层手工吻合组颈部吻合耗时均较机械管状吻合组和三角吻合组长,整个手术耗时也均较机械管状吻合组和三角吻合组长(均P<0.05)。全层手工吻合组和分层手工吻合组术后吻合口瘘发生率均高于机械管状吻合组和三角吻合组(均P<0.05)。全层手工吻合组、分层手工吻合组和三角吻合组术后吻合口狭窄发生率均低于机械管状吻合组(均P<0.05)。全层手工吻合组、分层手工吻合组、机械管状吻合组和三角吻合组在>5 min的返流次数、总返流时间百分比和最长返流时间方面比较,差异均无统计学意义(均P>0.05)。结论三角吻合耗时较短,术后吻合口瘘发生率以及吻合口狭窄发生率均较低,值得临床推广。

Objective To compare the application effects of full-layer manual anastomosis,stratified manual anastomosis,mechanical tubular anastomosis and triangular anastomosis in esophagogastric anastomosis.Methods A total of 314 patients with esophageal can-cer in Wuhan First Hospital from January 2015 to November 2020 were selected as the research subjects.Patients were divided into the full-layer manual anastomosis group(n=67),stratified manual anastomosis group(n=79),mechanical tubular anastomosis group(n=88)and triangular anastomosis group(n=80),according to the different anastomosis methods.The time of cervical anastomosis,the total operation time,the incidence of postoperative anastomotic leakage,the incidence of anastomotic stenosis,and the postoperative gastroesophageal re-flux were compared in the four groups.Results The time of cervical anastomosis in the full-layer manual anastomosis group and stratified manual anastomosis group was longer than that in the mechanical tubular anastomosis group and triangular anastomosis group,and the total operation time was also longer than that in the mechanical tubular anastomosis group and triangular anastomosis group(all P<0.05).The incidence of postoperative anastomotic leakage in the full-layer manual anastomosis group and stratified manual anastomosis group was higher than that in the mechanical tubular anastomosis group and triangular anastomosis group(all P<0.05),and the incidence of postoper-ative anastomotic stenosis in the full-layer manual anastomosis group and stratified manual anastomosis group and triangular anastomosis group was lower than that in the mechanical tubular anastomosis group(all P<0.05).There was no significant difference in the number of>5 min reflux,percentage of total reflux time and the longest reflux time among the four groups(all P>0.05).Conclusions Triangular anasto-mosis takes a shorter time,and has lower incidence rates of postoperative anastomotic leakage and anastomotic stenosis,which is worthy of clinical promotion.