食管癌三切口手术中器械吻合后不同残胃长度对吻合口瘘的影响  

Effects of different residual gastric lengths on anastomotic fistula in patients with esophageal cancer after 3-incision surgery and instrumental anastomosis

作　　者：杨广义[1] 苏文中 张艳峰[1] 岳光成[1] 梁为民 YANG Guangyi;SU Wenzhong;ZHANG Yanfeng;YUE Guangcheng;LIANG Weimin(Anyang Tumor Hospital,Anyang Henan 455000,China)

机构地区：[1]安阳市肿瘤医院,河南安阳455000

出　　处：《中国民康医学》2018年第11期6-7,10,共3页Medical Journal of Chinese People’s Health

摘　　要：目的:探讨食管癌三切口手术中器械吻合后不同残胃长度对吻合口瘘的影响。方法:回顾性分析2011年8月至2015年12月河南省安阳市肿瘤医院胸一科收治的213例食管癌三切口手术患者的临床资料,食管胃器械吻合后,根据胃壁残端闭合后所剩的残胃长度,将患者分为两组,A组长度为0.5~1 cm,B组长度为1~2 cm,比较两组患者食管胃切口总引流量、吻合口瘘、吻合口狭窄及发生瘘后的愈合天数。结果:A组患者总引流量平均为(14.8±8.0)mL,明显少于B组的总引流量(21.3±8.5)mL(P<0.05);术后经造影证实A组发生吻合口瘘13例(11.4%),B组发生32例(32.3%),A组发生吻合口瘘比例明显小于B组(P<0.05);A组患者发生瘘后愈合时间为(6.6±2.2)d,少于B组的(7.4±2.4)d(P<0.05)。两组吻合口狭窄率比较,差异无统计学意义(P>0.05)。结论:食管癌三切口手术中器械吻合后残胃长度在0.5~1.0 cm时可减少总引流量、吻合口瘘的发生率、瘘后愈合时间和吻合口狭窄的效果优于器械吻合后残胃长度在1~2 cm的效果。Objective:To investigate effects of different residual gastric lengths on anastomotic fistula in patients with esophageal cancer after 3-incision surgery and instrumental anastomosis.Methods:The clinical data of 213 patients with esophageal cancer undergone the 3-incision surgery from August 2011 to December 2015 in Anyang tumor hospital were retrospectively analyzed.After instrumental anastomosis of esophageal and gastric neck,these patients were divided into two groups according to the residual gastric length after closure of gastric wall.The length of group A was 0.5-1 cm,and the length of group B was 1-2 cm.The total drainage of neck incision,anastomotic fistula,anastomotic stenosis and the number of healing days after fistula of the two groups were compared.Results:The total drainage in group A(14.8±8.0 mL)was significantly less than that in group B(21.3±8.5 mL,P<0.05).The angiography showed that the cases with anastomotic fistula in group A(n=13,11.4%)was significantly less than that in group B(n=32,32.3%P<0.05),and the anastomotic fistula ratio was also significantly less than that in group B(P<0.05).The healing time after fistula in group A(6.6±2.2 d)was significantly lower than that in group B(7.4±2.4d,P<0.05).There was no significant difference in the incidence of anastomotic stenosis between the two groups(P>0.05).Conclusions:For the patients with esophageal cancer after 3-incision surgery and instrumental anastomosis,0.5-1.0cm residual gastric length can more effectively reduce the total drainage volume,anastomotic fistula and anastomotic stenosis incidences,and healing time after fistula than 1-2 cm residual gastric length.

关 键 词：食管癌 吻合口瘘 残胃长度 效果 

分 类 号：R735.1[医药卫生—肿瘤]