食管斜切断粘膜延长与胃分层吻合在贲门癌、食管癌手术中的应用  

An Esophagogastric Layer-by-layer Anastomoses with Inclined Incition and Prolonged Mucosa in Esophagus for Surgical Treatment of Esophageal Carcinoma

作　　者：火旭东[1] 王文才[1] 胥立根 张亚军[1] 郑如恒[2] 

机构地区：[1]江苏省盐城市第三人民医院胸外科,盐城224001 [2]复旦大学附属中山医院胸外科,上海200032

出　　处：《中国临床医学》2005年第2期213-214,共2页Chinese Journal of Clinical Medicine

摘　　要：目的:观察一种新的食管-胃吻合术预防吻合口狭窄和反流的效果.方法:同期行食管、贲门癌手术病人160例,随机分成两组:实验组80例,应用食管斜切断粘膜延长与胃分层吻合术;对照组80例,应用常规的食管-胃吻合术,术后随访6个月以上,记录吻合口瘘、狭窄和反流的发生率.结果:两组吻合口瘘的发生率:实验组0(0/80),对照组0.0125(1/80)(χ2=0.006,p=0.83).两组吻合口的口径:实验组≥1.5 cm 62例;1.0～1.5 cm 16例;≤1.0 cm 2例;而对照组相应的例数分别为31,34,14(χ2=25.81,p＜0.001).两组吻合口的反流例数:实验组8例,对照组34例(χ2=20.12,p＜0.001).结论:食管斜切断粘膜延长与胃分层吻合术能有效的预防吻合口的狭窄和反流.可改善术后病人的生存质量.Objective: To evaluate an improved esophagogastric anastomotic suturing technique′s effects on preventing anastomotic leak,stenosis,gastoesophageal reflux.Methods: From June 2002 to December 2003, 160 patients with esophageal carcinoma were randomly divided into experimental group surgically treated by an improved esophagogastric anastomoses and control group by conventional esophagogastric anastomoses.All the patients were followed up at least 6 months. Postoperative leak, stenosis, gastroesophageal reflux were recorded in both gruops.Results: The two groups showed no significant difference in leaks(experimental 0, control 1;χ 2=0.006,p=0.83);The experimental group had a lower stricture rate(experimental 2/80,control 14/80;χ 2=10.00,p< 0.01) and a lower gastroesophageal reflux rate (experimental 8/80,control 34/80;χ 2=20.12,p< 0.001).Conclusion:The improved esophagogastric anastomotic suturing technique had advantages to prevent anastomotic leak,stenosis and gastroesophageal reflux.

关 键 词：粘膜延长 贲门癌 手术中 食管癌 食管-胃吻合术 分层吻合术 吻合口瘘 吻合口狭窄 实验组 对照组 手术病人 术后随访 生存质量 术后病人 发生率 反流 预防 

分 类 号：R656[医药卫生—外科学] R735.1[医药卫生—临床医学]