机构地区:[1]济南军区总医院胸外科,250031
出 处:《中华消化外科杂志》2018年第8期856-860,共5页Chinese Journal of Digestive Surgery
基 金:全军医药卫生科研基金(08618)
摘 要:目的:探讨管状胃间置替代被切除食管和胃在食管胃双源肿瘤根治术中的应用价值。方法:采用回顾性横断面研究方法。收集2013年1月至2016年12月济南军区总医院收治的6例食管胃双源肿瘤患者的临床病理资料。6例患者中,中段食管癌2例,下段食管癌4例;胃窦部肿瘤4例,小弯侧胃体部肿瘤3例(其中1例患者胃窦部肿瘤和小弯侧胃体部肿瘤同时存在)。同期切除食管癌和胃肿瘤,采用近端胃替代被切除食管和胃,胃网膜右血管供血。管状胃近端均与食管吻合,远端吻合方式根据食管和胃 切除范围分别为:(1)病例1采用管状胃十二指肠Billroth Ⅰ式吻合术。(2)病例2、3、4采用管状胃空肠Billroth Ⅱ式吻合术。(3)病例5和6采用管状胃空肠Billroth Ⅱ式吻合术+空肠空肠侧侧吻合术。观察指标:(1)术中和术后恢复情况。(2)术后病理学检查情况。(3)随访和生存情况。采用门诊和电话方式进行随访,了解患者术后生存情况及生命质量。随访时间截至2017年5月。正态分布的计量资料以±s表示,偏态分布的计量资料以M(范围)表示。结果:(1)术中和术后恢复情况:6例患者均顺利完成手术,手术时间为(206±50)min,术中出血量为(106±24)mL,术后胃肠功能恢复时间为(3.8±2.1)d,术后引流管拔除时间为(6.8±5.0)d。6例患者中,1例术后发生吸入性肺炎,1例发生不全性肠梗阻,均经内科治疗治愈;无吻合口并发症发生。术后住院时间为(12.5±4.2)d。(2)术后病理学检查情况:6例患者淋巴结清扫数目为(13±3)枚,病例2存在腹部淋巴结转移。肿瘤病理学类型:食管肿瘤均为鳞癌,胃肿瘤中5例为腺癌、 1例为间质瘤。(3)随访和生存情况:6例患者均获得术后随访,随访时间为5~28个月,中位随访时间为14个月。随访期间,病例1反流�Objective:To investigate the application value of tubular gastric interposition for esophageal reconstruction in esophageal and gastric cancer. Methods:The retrospective crosssectional study was conducted. The clinicopathological data of 6 patients with esophageal and gastric cancer who were admitted to the General Hospital of Jinan Military Area of PLA between January 2013 and December 2016 were collected. Among 6 patients, 2 and 4 were respectively confirmed as midthoracic and low esophageal cancers; tumors of 4 and 3 patients were respectively located in the gastric antrum and gastric body at lesser curvature side, including 1 with tumor in the gastric antrum and body. Esophageal cancer and gastric tumor were simultaneous resected, and proximal stomach replaced esophagus resected, with a blood-supply through right gastroepiploic vessels. There was an anastomosis between proximal tubular stomach and esoghagus. According to resection extent of resection extent, distal anastomosis included: (1) tubular stomachduodenum BillrothⅠ anastomosis in case 1; (2) tubular stomachjejunum Billroth Ⅱ anastomosis in case 2, 3 and 4; (3) tubular stomachjejunum Billroth Ⅱ anastomosis + jejunum-jejunum side-to-side anastomosis in case 5 and 6. Observation indicators: (1) intra-and post-operative recovery situations; (2) postoperative pathological examination; (3) followup and survival situations. Follow-up using outpatient examination and telephone interview was performed to detect postoperative survival and quality of life up to May 2017. Measurement data with normal distribution were represented as ±s. Measurement data with skewed distribution were described as M (range). Results:(1) Intra and postoperative recovery situations: 6 patients underwent successful operation. The operation time, volume of intraoperative blood loss, gastrointestinal function recovery time, drainagetube removal time and duration of hospital stay were respectively (206± 50)minutes, (106±24)m
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