机械吻合和手工吻合两种食管癌切除术的比较  

Comparative analysis of mechanical and manual cervical esophagogastric anastomosis following esophagectomy for esophageal cancer

作　　者：蔡瑞君[1] 李梅[1] 熊刚[1] 蔡开灿[1] 王武军[1] 

机构地区：[1]南方医科大学南方医院心胸血管外科,广东广州510515

出　　处：《南方医科大学学报》2012年第6期908-909,912,共3页Journal of Southern Medical University

摘　　要：目的探讨食管癌切除食管胃颈部机械吻合及手工吻合两种手术方式的并发症及防治。方法2004年9月~2008年6月，将颈段及胸中、上段食管癌并具有手术适应症的患者随机分为两组即手工吻合组（手工组）和圆形吻合器机械吻合组（机械组），比较两组吻合口瘘、狭窄等的并发症。结果手工组125例，机械组102例，吻合瘘发生率分别为14.4%（18/125）、2.9%（3/102），狭窄需扩张分别为8.8.%（11/125），3.9%（4/102）。颈部吻合时间分别为（52±12）min和（25±5）min，差别显著（P〈0.01）。结论食管癌切除食管胃颈部采用圆形吻合器端侧吻合吻合口瘘发生率低，手术时间缩短，操作简便，易于掌握及标准化，有利于降低吻合口的并发症。Objective To compare the complications associated with mechanical and manual cervical esophagogastric anastomosis following esophagectomy for esophageal cancer. Methods From September, 2004 to June, 2007, 227 patients with middle and upper thoracic esophageal cancer underwent cervical esophagogastric anastomosis after esophagectomy. The patients were randomized into two groups and cervical esophagogastric anastomosis was performed using a stapler （n=102） or manually （n=125）. The incidence of postoperative complications and operative time were compared between the two groups. Results In manual anastomosis group, anastomotic leak and anastomotic stricture occurred in 14.4% （18/125） and 8.8.% （11/ 125） of the patients, significantly higher than the incidences of 2.9% （3/102） and 3.9% （4/102） in the mechanical anastomosis group （P〈0.01）. Manual anastomosis required a significantly longer operative time than mechanical anastomosis （52±12 vs 25±5 min, P〈0.01）. Conclusion The use of circular mechanical stapler in cervical esophagogastric anastomosis is associated with a lower rate of anastomotic leak and a shorter operative time, and is easy to learn and standardize to reduce the complications of the anastomosis.

关 键 词：食管癌 吻合 并发症 

分 类 号：R735.1[医药卫生—肿瘤]