两种不同方法制作管状胃在食管癌手术中的应用  

Two methods of tubular stomach in esophageal surgery

作　　者：王立杰[1] 吴骏[1] 张建鹏[1] 王艳瑜[1] 

机构地区：[1]首都医科大学潞河教学医院胸心外科,北京101149

出　　处：《中国医师进修杂志》2014年第2期9-11,共3页Chinese Journal of Postgraduates of Medicine

摘　　要：目的 总结食管癌手术中两种管状胃的制作方法及术后并发症发生情况,以探讨哪种方法更有优势.方法 选择行手术治疗的食管癌患者47例,采用抽签法随机分为两组,机械裁剪胃小弯制作管状胃24例（A组）,手工缝缩胃小弯制作管状胃23例（B组）,对两组术后主要并发症进行分析比较.结果 两组均行肿瘤根治切除,无手术相关死亡病例,术后A组并发胃内切缘急性出血1例,B组并发吻合口瘘及胸胃瘘各1例;随访12个月,A组并发吻合口狭窄1例,B组4例,两组比较差异无统计学意义（P＞0.05）;术后3,6,12个月上消化道造影、CT检查,A、B两组均无明显排空障碍,两组膈上胸胃均有不同程度扩张,且B组较A组扩张明显,其中B组有3例部分胸胃侧方突入胸腔;A组有1例进食后出现胸胃综合征,B组并发胸胃综合征3例,两组比较差异无统计学意义（P＞0.05）;A组并发反流性食管炎3例,反流症状较轻,B组并发反流性食管炎10例,两组比较差异有统计学意义（P＜0.05）.结论 在食管癌手术中机械裁剪胃小弯制作管状胃与手工缝缩胃小弯制作管状胃两种方法比较,前者更有优势,值得临床优先选择.Objective To explore which method is more advantaged by comparing two kinds of tubular stomach in esophageal cancer operation and the occurrence of postoperative complications.Methods There were 47 esophageal cancer patients and they were randomly divided into two groups：A group including 24 patients and making mechanical clipping lesser curvature,B group including 23 patients and hand-sewn shrink lesser,and the major complications were analyzed and compared.Results All patients underwent radical tumor resection without the operative mortality.There was 1 patient of acute hemorrhagic of gastric resection margin in A group,and there was 1 patient of thoracic gastric leakage and 1 patient of anastomotic fistula in B group.In 12-month follow-up,there was 1 patient of anastomotic narrow in A group and 4 cases in B group （P ＞ 0.05）.After 3,6 and 12 months,emptying dysfunction was not found by upper gastrointestinal imaging and CT,but the thoracic stomach expansion was found in two groups,and the degree of thoracic stomach expansion in B group was more serious than that in A group,the part of the thoracic stomach of 3 patients in B group protruding into the opposite chest.There was 1 patient with thoracic-gastro syndrome after eating in A group and 3 patients in B group （P ＞ 0.05）.There were 3 patients with mild reflux esophagitis in A group and 10 patients with serious reflux esophagitis in B group （P＜0.05）.Conclusion Comparing two operative methods,the mechanical clipping lesser curvature is more advantaged than hand-sewn shrink lesser.

关 键 词：食管肿瘤 手术后并发症 管状胃 重建食管 

分 类 号：R735.205[医药卫生—肿瘤]