全腔镜食管癌三野根治术颈部机械吻合与手工吻合的应用比较  

Comparison of the stapled suture with the manual suture in the application of minimally invasive esophagectomy

作　　者：王枫[1] 柳硕岩[1] 王健键[1] 陈啸风[1] 郑庆丰[1] 王镇[1] 徐建建[1] 陈赛云[1] 

机构地区：[1]福建省肿瘤医院胸外科,福州350014

出　　处：《中华胃肠外科杂志》2014年第9期881-883,共3页Chinese Journal of Gastrointestinal Surgery

摘　　要：目的：评估全腔镜食管癌三野根治术食管胃颈部吻合方式（机械或手工）对术后吻合口相关并发症发生的影响。方法回顾性分析2010年1月至2013年11月间在福建省肿瘤医院胸外科接受全腔镜食管癌三野根治术治疗的203例食管癌患者的临床资料。根据颈部吻合方式的不同，分为机械吻合组（104例）和手工吻合组（99例）。比较两组患者术后吻合口相关并发症发生率。结果机械吻合组术中吻合时间较手工吻合组明显缩短[（15．5±5．0） min比（28．0±4．5） min，P＜0．01]。两组术后吻合口瘘发生率分别为5．8％（6/104）和3．0％（3/99），差异无统计学意义（P＞0．05）；吻合口狭窄发生率分别为9．6％（10/104）和2．0％（2/99），差异有统计学意义（P＜0．05）。结论与手工吻合相比，全腔镜食管癌三野根治术食管胃颈部机械吻合操作简单、吻合确切，但吻合口狭窄的风险增加，因此，在临床实践中，应结合患者的具体情况合理选择吻合方式。Objective To compare the associated anastomotic complication of cervical esophagogastric anastomosis between stapled and hand-sewn anastomosis in minimally invasive esophagectomy （MIE）. Methods Clinical data of 203 patients with esophageal cancer receiving combined thoracoscopic and laparoscopic esophagectomy with anastomosis in the neck in our hospital from January 2010 to November 2013 were retrospectively analyzed. All the patients were divided into stapled group （104 patients） and hand-sewn group （99 patients）. The incidence of anastomotic leakage and anastomotic stricture between these two groups were compared. Results There were no significant differences between two groups in gender, age, body mass index, total protein, albumin, and neoadjuvant chemotherapy （all P〉0.05）. There was no significant difference between the two groups in the incidence of anastomotic leakage[6/104（5.77%） vs. 3/99（3.03%）, P〉0.05], while the difference in the incidence of anastomotic stricture was significant [10/104（9.62%） vs. 2/99（2.02%）, P〈0.05]. The time of anastomosis, dieting and hospital stay was （15.5±5.0） min, （5.0±2.8） d and （18.3±5.9） d in stapled group, which was significantly shorter than （28.0±4.5） min, （5.9±1.2） d and （21.8±4.2） d in hand-sewn group （all P〈0.05）. Conclusion In the minimally invasive esophagectomy, stapled cervical esophagogastric anastomosis is simple and precise , but it is associated with increased risk of anastomotic stricture, therefore the type of anastomosis should be chosen based on the conditions of the patient.

关 键 词：食管肿瘤 食管切除术 胸腔镜 腹腔镜 机械吻合 手工吻合 

分 类 号：R735.1[医药卫生—肿瘤]