胸腔镜食管癌根治术中三种吻合方式的比较  

Comparison of three ways of anastomosis in the application of thoracoscopic esophagectomy

作　　者：侯建国[1] 石力伟[1] 赵献军[1] 

机构地区：[1]河南省林州市肿瘤医院,456550

出　　处：《中国实用医刊》2016年第22期50-53,共4页Chinese Journal of Practical Medicine

摘　　要：目的：评估食管癌胸腔镜根治术食管胃颈部吻合方式对术后吻合口相关并发症发生的影响。方法回顾性分析2013年1月至2015年12月175例行胸腔镜食管癌根治术的食管癌患者的临床资料，根据颈部吻合方式的不同，将其分为包套式手工吻合组（55例）、单层手工吻合组（59例）和机械吻合组（61例），比较各组术后吻合口瘘、吻合口狭窄、吻合口反流等相关并发症发生率。结果三组患者的性别、年龄、肿瘤分期、肿瘤部位及体质量指数等一般资料比较差异均未见统计学意义（P〉0.05）。包套式手工吻合组、单层手工吻合组和机械吻合组术后吻合口瘘发生率分别为1.8%（1/55）、15.3%（9/59）、9.8%（6/61），且包套式手工吻合组与单层手工吻合组术后吻合口瘘发生率比较差异有统计学意义（P〈0.05）；包套式手工吻合组、单层手工吻合组和机械吻合组术后吻合口狭窄的发生率分别为3.6%（2/55）、33.9%（20/59）、18.0%（11/61），且三组的术后吻合口狭窄发生率比较差异均有统计学意义（P〈0.05）；包套式手工吻合组、单层手工吻合组和机械吻合组术后吻合口反流发生率分别为21.8%（12/55）、52.5%（31/59）、63.9%（39/61），且包套式手工吻合组与单层手工吻合组和机械吻合组的术后吻合口反流发生率比较差异均有统计学意义（P〈0.05）。结论胸腔镜食管癌根治术食管胃颈部包套式手工吻合术的吻合口相关并发症的发生率较低，是一种安全的手术方式。Objective To assess the related anastomotic complications of cervical esophagogas-tric anastomosis among the sheath-style anastomosis,the manual monolayer anastomosis and the stapled anastomosis in thoracoscopic esophagectomy. Methods The clinical data of 175 patients with esophageal cancer receiving combined thoracoscopic and laparoscopic esophagectomy from January 2013 to December 2015 were retrospecctively analyzed. All the patients were divided into sheath-style anastomosis group （55 cases）,manual monolayer anastomosis group（59 cases）and stapled anastomosis group（61 cases） according to the anasomosis in the neck. The incidences of anastomotic leakage,anastomotic stricture and anastomotic regurgitation among the groups were compared. Results There was no significant difference among the groups in gender,age,tumor stage,tumor location or body mass index（all P〉 0. 05）. The incidences of anastomotic leakage in the sheath-style anastomosis group,the manual monolayer anastomo-sis group and the stapled anastomosis group were respectively 1. 8%（1 / 55）,15. 3%（9 / 59）and 9. 8%（6 / 61）,while the difference was significant between manual monolayer anastomsis group and stapled an-astomosis group（P〈 0. 05）. There were significant differences among the three groups in the incidence of anastomotic stricture[3. 6%（2 / 55）,33. 9%（20 / 59）,18. 0%（11 / 61）,P all〈 0. 05]. There was no significant difference between the manual monolayer anastomosis and the stapled anastomosis group in the incidence of anastomotic regurgitation[52. 5%（31 / 59）vs 63. 9%（39 / 61）,P〉 0. 05],while the differ-ences were significant in other groups[21. 8%（12 / 55）vs 52. 5%（31 / 59）,21. 8%（12 / 55）vs 63. 9%（39 / 61）,P all〈 0. 05]. Conclusions In the thoracoscopic esophagectomy,cervical esophagogastric sheath-style anastomosis can reduce the risk of anastomotic related complications,therefore the type of anastomosis is safe.

关 键 词：食管癌 胸腔镜 包套式手工吻合 单层手工吻合 机械吻合 

分 类 号：R735.1[医药卫生—肿瘤]