管状胃-食管吻合术与食管胃弓上吻合术在胸腔镜食管癌根治术患者中的应用效果比较

Comparison of application effects of tubular gastroesophagostomy and esophagogastric arch anastomosis in patients undergoing thoracoscopic esophageal cancer radical surgery

目的:比较管状胃-食管吻合术与食管胃弓上吻合术在胸腔镜食管癌根治术患者中的应用效果。方法:回顾性分析2020年1月至2023年5月该院收治的86例食管癌患者的临床资料,按照消化道重建方式不同将其分为观察组和对照组各43例。两组均行胸腔镜根治术治疗,对照组采用食管胃弓上吻合术,观察组采用管状胃-食管吻合术,两组术后均随访3个月。比较两组围术期指标(手术时间、胃肠减压量、术中出血量、住院时间)水平,手术前后胃功能指标(胃蠕动收缩压、胃腔内静息压、胃蠕动频率)水平、营养指标[总蛋白(TP)、白蛋白(ALB)、血红蛋白(Hb)]水平、生命质量[癌症患者生命质量测定量表(QLQ-C30)]评分,以及并发症发生率。结果:观察组手术时间、住院时间均短于对照组,术中出血量、胃肠减压量均少于对照组,差异有统计学意义(P<0.05);术后1个月,观察组胃蠕动收缩压、胃腔内静息压、胃蠕动频率均高于对照组,差异有统计学意义(P<0.05);术后3个月,观察组血清ALB、TP、Hb水平和QLQ-C30评分均高于对照组,差异有统计学意义(P<0.05);观察组并发症发生率为4.65%(2/43),低于对照组的23.26%(10/43),差异有统计学意义(P<0.05)。结论:管状胃-食管吻合术应用于胸腔镜食管癌根治术患者可优化围术期指标水平,改善胃功能指标和营养指标水平,提高生命质量评分,降低并发症发生率,效果优于食管胃弓上吻合术。

Objective:To compare application effects of tubular gastroesophagostomy and esophagogastric arch anastomosis in patients undergoing thoracoscopic esophageal cancer radical surgery.Methods:The clinical data of 86 patients with esophageal cancer admitted to the hospital from January 2020 to May 2023 were retrospectively analyzed.According to the different ways of digestive tract reconstruction,they were divided into observation group and control group,43 cases in each group.Both groups were treated with thoracoscopic radical surgery.The control group was treated with esophagogastric arch anastomosis,while the observation group was treated with tubular gastroesophagostomy.Both groups were followed up for 3 months.The perioperative indexes(operation time,gastrointestinal decompression volume,intraoperative blood loss,hospitalization time),gastric function indexes levels(gastric peristalsis systolic pressure,gastric cavity resting pressure,gastric peristalsis frequency)before and after the surgery and nutritional indexes levels[total protein(TP),albumin(ALB),hemoglobin(Hb)],the quality of life[quality of life questionnaire for cancer patients(QLQ-C30)]score,and the incidence of complications were compared between the two groups.Results:The operation time and the hospitalization time of the observation group were shorter than those of the control group,the intraoperative blood loss and the gastrointestinal decompression volume were less than those of the control group,and the differences were statistically significant(P<0.05).1 month after the surgery,the gastric peristalsis systolic pressure,the gastric cavity resting pressure and the gastric peristalsis frequency in the observation group were higher than those in the control group,and the differences were statistically significant(P<0.05).3 months after the surgery,the levels of serum ALB,TP,Hb and the QLQ-C30 score in the observation group were higher than those in the control group,and the differences were statistically significant(P<0.05).Further,the incidence of complications in the observation group was 4.65%(2/43),which was lower than 23.26%(10/43)in the control group,and the difference was statistically significant(P<0.05).Conclusions:Tubular gastroesophagostomy for the patients undergoing thoracoscopic esophageal cancer radical surgery can optimize the perioperative index levels,improve the levels of gastric function indexes and nutritional indexes,improve the quality of life scores,and reduce the incidence of complications.Moreover,it is superior to esophagogastric arch anastomosis.