食管癌切除术后颈部食管胃侧侧吻合与手工端侧吻合效果的对照研究  

Comparison of esophagogastric side-side anastomosis and hand-sewn end-side anastomosis in neck after esophagectomy for carcinoma

作　　者：杨列[1] 郑轶峰[1] 姜建青[1] 俞永康[1] 郑琇山[1] 李卫[1] 

机构地区：[1]成都军区总医院心胸外科,成都610083

出　　处：《重庆医学》2012年第30期3155-3156,3159,共3页Chongqing medicine

摘　　要：目的研究颈部食管与管状胃侧侧吻合在食管癌术中的应用效果。方法将该科收治的44例胸段食管癌患者随机分为侧侧吻合组和全手工吻合组各22例。所有患者均行经右胸、腹部、颈部三切口食管癌切除、管状胃成形,并于颈部行食管胃吻合;侧侧吻合组采用内镜切割缝合器及全手工吻合相结合行食管与胃侧侧吻合,全手工吻合组采用间断分层缝合方法行食管胃端侧吻合。结果所有患者均顺利完成手术,术后侧侧吻合组失访1例。侧侧吻合组吻合口瘘1例,全手工吻合组吻合口瘘1例;全手工吻合组吻合口狭窄3例(13.7%),侧侧吻合组未发现吻合口狭窄病例,两组间比较差异有统计学意义(P<0.05)。两组患者吻合口狭窄、吻合口瘘、嗳酸、烧心及胃镜下反流性食管性等方面比较,差异无统计学意义(P>0.05)。结论食管癌术中颈部食管与管状胃侧侧吻合可有效预防吻合口狭窄。Objective To investigate the effect of esophagogastric side to side anastomosis in neck after esophagectomy and gastric tube reconstruction on esophageal carcinoma patients.Methods 44 patients with thoracic esophageal carcinoma scheduled to undergo esophagectomy and esophagogastric anastomosis in neck were enrolled.They were randomly assigned into two groups of 22：the hand-sewn anastomosis group（HSA） and the side to side anastomosis（SSA）group.All the patients received three-incisions esophagectomy and gastric tube reconstruction.The patients in HSA group received two layers hand-sewn esophagogastric anastomosis in the neck and the patients in SSA group received side to side esophagogastric anastomosis with linear stapler and two layers hand-sewn in the neck.Results All the patients were operated successfully.One case in SSA group was lost in follow-up.There was one patient with anastomastic leak in each group.There were 3 patients with anastomastic stricture in HSA group and but no one in SSA group.istically.There was difference between two groups statistically.There was no difference between two groups statiseicolly heart burning、regvrgitostion、reflux esophagitis.Conclusion Esophagogastric side to side anastomosis in neck after esophagectomy in esophageal carcinoma patients reduce the incidence of the anastomostic leak compared with layers hand-sewn anastomosis.

关 键 词：食管肿瘤 管状胃 吻合术 外科 

分 类 号：R735.1[医药卫生—肿瘤]