食管胃颈部侧侧T吻合在胸腹腔镜联合下食管癌根治术中的应用

Application of esophagogastric side-to-side T-type anastomosis in combined thoraco-laparoscopic radical resection of esophageal carcinoma

目的:探讨食管胃颈部侧侧T型吻合在胸腹腔镜联合下食管癌根治术中的临床效果。方法:选取行胸腹腔镜联合食管癌根治术治疗的病人66例,根据病人颈部吻合方式不同分为观察组(30例)和对照组(36例),观察组采用T型全机械侧侧吻合治疗,对照组采用颈部管状吻合。比较2组病人术中颈部吻合时间、出血量及术后1个月吻合口瘘、术后6个月吻合口狭窄及食管胃反流情况。结果:围手术期内2组病人无死亡。观察组病人吻合时间和6个月吻合口狭窄发生率均明显低于对照组(P<0.01);2组病人术中出血量、术后1个月吻合口瘘发生率、术后6个月胃食管反流发生率差异均无统计学意义(P>0.05)。结论:在胸腹腔镜联合下食管癌根治术中,应用胃食管颈部侧侧T型吻合可有效缩短手术操作时间,减少吻合口狭窄的发生率,值得临床推广。

Objective:To investigate the clinical effect of cervical esophagogastric side-to-side T-type anastomosis in combined thoraco-laparoscopic radical resection of esophageal carcinoma.Methods:Sixty-six patients who underwent combined thoraco-laparoscopic radical resection of esophageal carcinoma were selected and divided into observation group(30 cases)and control group(36 cases)according to the cervical anastomosis method.The observation group was treated with T-type side-to-side anastomosis,and the control group was treated with cervical tubular anastomosis.The intraoperative cervical anastomosis time,blood loss during operation,anastomotic leakage at 1 month after operation,anastomotic stenosis and esophagogastric reflux at 6 months after operation were compared between the two groups.Results:There was no death in the two groups during the perioperative period.The anastomosis time and the incidence of anastomotic stenosis in observation group were significantly lower than those in control group(P<0.01).There was no significant difference in the blood loss during operation,and incidence of anastomotic leakage at 1 month after operation and esophagogastric reflux at 6 months after operation between the two groups(P>0.05).Conclusions:The application of cervical esophagogastric side-to-side T-type anastomosis in combined thoraco-laparoscopic radical resection of esophageal carcinoma can effectively shorten the operation time and reduce the incidence of anastomotic stenosis,which is worthy of clinical promotion.