不同吻合方式在食管胃结合部腺癌腹腔镜手术中的应用效果比较

Comparison of the application effect of different anastomosis methods in laparoscopic surgery for adenocarcinoma of esophagogastric junction

目的 比较食管胃结合部腺癌(AEG)腹腔镜手术中不同吻合方式的应用效果。方法 选择2018年1月至2020年12月黄河三门峡医院收治的92例AEG患者为研究对象,所有患者行腹腔镜下根治性全胃切除术,根据术中吻合方式将患者分为A组(n=47)和B组(n=45);A组患者行食管空肠半端端吻合,B组患者行食管空肠端侧吻合。比较2组患者的手术情况(手术时间、术中出血量、消化道重建时间)和术后恢复指标(首次肛门排气时间、术后首次进水时间、术后首次进食时间、术后拔管时间、术后住院时间)。记录2组患者术中及术后食管空肠吻合相关并发症发生情况。结果 A组患者的手术时间及消化道重建时间显著短于B组(P<0.05);2组患者术中出血量比较差异无统计学意义(P>0.05)。2组患者术后首次肛门排气时间、术后首次进水时间、术后首次进食时间、术后拔管时间及术后住院时间比较差异均无统计学意义(P>0.05)。A组患者术中吻合口出血发生率和术后吻合口出血发生率、吻合口瘘发生率均为2.13%(1/47);B组患者术中吻合口出血发生率为4.44%(2/45),术后吻合口狭窄发生率、吻合口瘘发生率分别为15.56%(7/45)、8.89%(4/45)。2组患者术中吻合口出血发生率及术后吻合口出血发生率、吻合口瘘发生率比较差异无统计学意义(χ^(2)=0.001、0.000、0.941,P>0.05);A组患者术后吻合口狭窄发生率显著低于B组(χ^(2)=5.855,P<0.05)。结论 与食管空肠端侧吻合相比,AEG患者腹腔镜手术中行食管空肠半端端吻合可缩短手术时间、消化道重建时间,减少术后吻合口狭窄的发生。

Objective To compare the application effect of different anastomosis methods in laparoscopic surgery for adenocarcinoma of esophagogastric junction(AEG).Methods A total of 92 AEG patients admitted to Yellow River Sanmenxia Hospital from January 2018 to December 2020 were selected as research subjects.All patients underwent laparoscopic radical total gastrectomy,and the patients were divided into group A(n=47)and group B(n=45)according to anastomosis method in laparoscopic surgery.The patients in the group A underwent semi-end-to-end esophagojejunostomy,the patients in the group B underwent end-to-side esophagojejunostomy.The surgical conditions(operation time,intraoperative bleeding,digestive tract reconstruction time)and postoperative recovery indicators(the first anal exhaust time,the first water intake time,the first food intake time,extubation time,hospitalization time)of patients were compared between the two groups.The complications related to esophagojejunal anastomosis during and after surgery of patients in the two groups were recorded.Results The operation time and digestive tract reconstruction time of patients in group A were significantly shorter than those in group B(P<0.05);there was no significant difference in intraoperative bleeding of patients between the two groups(P>0.05).There was no statistically significant difference in the first anal exhaust time,the first water intake time,the first food intake time,extubation time and the hospitalization time after operation of patients between the two groups(P>0.05).The incidences of intraoperative anastomotic bleeding,postoperative anastomotic bleeding,and anastomotic fistula of patients in group A were all of 2.13%(1/47);the incidence of intraoperative anastomotic bleeding of patients in group B was 4.44%(2/45);and the incidence of postoperative anastomotic stenosis and fistula were 15.56%(7/45)and 8.89%(4/45),respectively.There was no significant difference in the incidences of intraoperative anastomotic bleeding,postoperative anastomotic bleeding and anastomotic fistula of patients between the two groups(χ^(2)=0.001,0.000,0.941;P>0.05);the incidence of postoperative anastomotic stenosis of patients in group A was significantly lower than that in group B(χ^(2)=5.855,P<0.05).Conclusion Compared to end-to-side esophagojejunostomy,semi-end-to-end esophagojejunostomy in laparoscopic surgery can shorten the operation time,digestive tract reconstruction time,and reduce the occurrence of postoperative anastomotic stenosis in AEG patients.