不同加固术式在食管贲门癌机械吻合术后抗返流效果的比较  

Antireflux Effects of Different Reinforcement Procedure in Mechanical Anastomosis for Esophageal and Cardiac Carcinoma

作　　者：张英国 陈文元 王军贤 张雁山 姜晓萍 

机构地区：[1]甘肃省武威肿瘤医院胸外科,甘肃武威733000

出　　处：《中国普外基础与临床杂志》2011年第3期309-312,共4页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的比较唇式加固、胃底折叠His角重建与单纯机械吻合对食管贲门癌机械吻合术后的抗返流效果。方法纳入我科2008年3月至2009年10月期间的176例食管贲门癌患者,按入院时间先后分为三个阶段分别实施单纯机械吻合术(机械吻合组,n=42)、机械吻合胃底折叠His角重建术(His角重建组,n=56)及机械吻合唇式加固术(唇式加固组,n=78),术后3个月常规行胃镜检查并活检,以判断其抗返流效果。结果 3组患者间性别、年龄、肿瘤部位、吻合部位及切口部位比较差异均无统计学意义(P>0.05)。术后返流发生率机械吻合组、His角重建组及唇式加固组分别为69.05%、28.57%及14.10%,唇式加固组和His角重建组均明显低于机械吻合组(χ2=37.088,P=0.000;χ2=15.833,P=0.000),且唇式加固组又明显低于His角重建组(2χ=4.241,P=0.039)。唇式加固组无一例出现吻合口漏,术后均安全出院,仅有2例出现中度吻合口狭窄,经扩张后均恢复良好。术后返流发生与吻合部位无关(P>0.05)。结论唇式加固与胃底折叠His角重建在食管贲门癌机械吻合术中均有明显的抗返流作用,唇式加固的抗返流效果更佳,且操作简便。Objective To compare the antireflux effects of lip reinforcement,His angle reconstruction with fundoplication,and mechanical anastomosis only in mechanical anastomosis for esophageal and cardiac carcinoma.Methods One hundred and seventy-six patients with esophageal or cardiac carcinoma admitted to this hospital between March 2008 and October 2009 were included,which were divided into mechanical anastomosis group（n=42）,His angle reconstruction group（n=56）,and lip reinforcement group（n=78） according to the sequence of admission.Mechanical anastomosis only,mechanical anastomosis His angle reconstruction with fundoplication,and mechanical anastomosis lip-type reinforcement were performed in the corresponding group,respectively.Endoscopy and biopsy were conducted to evaluate the antireflux effects on 3 months after operation.Results There were no differences on the gender,age,tumor location,anastomosis site,and incision among three groups（P0.05）.The reflux rates of the mechanical anastomosis group,His angle reconstruction group,and lip reinforcement group were 69.05%,28.57%,and 14.10%,respectively.The reflux rates in the lip reinforcement group and His angle reconstruction group were significantly lower than those in the mechanical anastomosis group（χ2=37.088,P=0.000;χ2=15.833,P=0.000）,moreover,the rate in the lip reinforcement group was significantly lower than that in the His angle reconstruction group（χ2=4.241,P=0.039）.There was no anastomotic leakage in the lip reinforcement group and all patients safely discharged from hospital after surgery,only 2 patients had moderately anastomotic stenosis and both of them had good recovery with endoscopic dilatationl.The reflux after operation was independent of anastomosis sites（P0.05）.Conclusion Both lip-type reinforcement and His angle reconstruction can improve the ability of antireflux,lip-type reinforcement is better and simple to mainpulate.

关 键 词：食管贲门癌 单纯机械吻合 唇式加固 His角重建 返流 

分 类 号：R735[医药卫生—肿瘤]