食管切除术后管状胃不同上提径路的比较  

Comparison of retrosternal and posterior mediastinal gastric tube reconstruction after three-phase esophagectomy

作　　者：冯明祥[1] 王群[1] 蒋伟[1] 汪灏[1] 钱成[1] 谭黎杰[1] 

机构地区：[1]复旦大学附属中山医院胸外科,上海200032

出　　处：《中华胃肠外科杂志》2010年第1期33-35,共3页Chinese Journal of Gastrointestinal Surgery

摘　　要：目的 比较食管癌三切口手术后,管状胃经胸骨后和经食管床两种径路上提行胃食管颈部吻合的安全性和有效性.方法 回顾性分析2005年7月至2009年5月间107例行食管癌三切口手术患者的临床资料.结果 本组患者上提管状胃采用经胸骨后径路行胃食管颈部吻合者52例,经食管床径路者55例.两种径路吻合组在手术时间、术中出血量及胸管置管方面差异均无统计学意义（P＞0.05）.胸骨后径路组的住院时间[（12.9±9.4）d]长于食管床径路组[（9.9±5.4）d,P＜0.05].两组均无围手术期死亡病例.胸骨后径路组的吻合口瘘发生率（26.9%）明显高于食管床径路组（5.5%）（P＜0.01）;两组患者肺部感染、肺不张和心律失常等心肺并发症发生率差异无统计学意义（P＞0.05）.结论 经胸骨后和经食管床径路管状胃上提均为有效、安全的途径;但胸骨后径路术后吻合口瘘发生率较高.应个体化选择管状胃的上提径路.Objective To compare the outcome between retrosternal and posterior mediastinal gastric tube reconstruction after three-phase esophagectomy.Methods A total of 107 patients who underwent three-phase esophagectomy between July 2005 and May 2009 were enrolled in this study.Results There were 78 men and 29 women.Median age was 62.1 years.The tumor located at upper segment in 20 cases,middle segment in 69 cases and lower segment in 18 cases.There were 55 patients in the posterior mediastinal group and 52 in the retrosternal group.There were no significant differences between two groups in operation time,intraoperative blood loss,duration of chest tube.Hospital stay of retrosternal group was longer as compared to posterior mediastinal group.No death occurred in beth groups.Anastomotic leakage occurred more frequently in retrosternal group than that in posterior mediastinal group （26.9% vs 5.5%）.Postoperative pneumonia,atelectasis and arrhythmia were not significantly different between two groups.Conclusions After three-phase esophagectomy,both retrosternal and posterior mediastinal gastric tube reconstruction can be performed easily and safely.Morbidity of anastomotic leakage is higher in retrosternal reconstruction.Individualized gastric tube reconstruction should be considered.

关 键 词：食管肿瘤 食管切除术 管状胃 外科手术 

分 类 号：R735.1[医药卫生—肿瘤]