胸内反穿刺吻合法在腔镜食管中下段癌手术中的应用价值  

Value of intrathoracic reverse-puncture anastomosis in endoscopic middle and lower esophageal cancer operation

作　　者：秦华龙[1] 葛锦峰[1] 石壕屹 周开国 蒋东[1] 郑世营[1] 马海涛[1] QIN Hualong;GE Jinfeng;SHI Haoyi;ZHOU Kaiguo;JIANG Dong;ZHENG Shiying;MA Haitao(Department of Thoracic Surgery,The First Affiliated Hospital of Soochow University,Suzhou,Jiangsu,215006)

机构地区：[1]苏州大学附属第一医院胸外科,江苏苏州215006

出　　处：《实用临床医药杂志》2018年第24期33-36,40,共5页Journal of Clinical Medicine in Practice

基　　金：江苏省苏州市科教兴卫青年科技项目(kjxw2015002)

摘　　要：目的探讨胸内反穿刺吻合法在全腔镜下行Ivor-Lewis手术治疗食管中下段癌中的应用价值。方法回顾性分析58例接受全腔镜Ivor-Lewis术的食管中下段癌患者的资料,按照术中胸内吻合方式分为反穿刺吻合组(28例)和手工荷包吻合组(30例),分析胸内反穿刺吻合法在Ivor-Lewis术治疗食管中下段癌的适应证及安全性。结果 2组患者的性别、年龄、术中出血量、淋巴结清扫个数无显著差异(P> 0. 05),反穿刺吻合组肿瘤位置较手工荷包吻合组低,手术时间较手工荷包吻合组短,差异有统计学意义(P <0. 05)。2组术后肺部感染发生率、术后吻合口瘘及狭窄发生率、住院时间及术后TNM分期差异无统计学意义(P> 0. 05)。结论对于肿瘤位于奇静脉弓下的食管中下段癌,全胸腔镜下选择反穿刺吻合法行Ivor-Lewis手术是安全可行的。Objective To evaluate the application value of intrathoracic reverse-puncture anastomosis in endoscopic Ivor-Lewis operation for middle and lower esophageal cancer.Methods A retrospective analysis was performed for 58 patients with middle and lower esophageal cancer who underwent total endoscopic Ivor-Lewis operation.The patients were divided into intrathoracic reverse puncture anastomosis group(28 cases)and manual purse anastomosis group(30 cases)according to the method of intrathoracic anastomosis.The indication and safety of intrathoracic reverse-puncture anastomosis in endoscopic Ivor-Lewis operation for the treatment of middle and lower esophageal cancerwas analyzed.Results There were no significant differences in sex,age,intraopertive bleeding,and numbers of nodal dissection between the two groups(P>0.05).The tumor location in the intrathoracic reverse-puncture anastomosis group was lower,and the operative duration was shorter than that in the manual purse anastomosis group(P<0.05).There were no significant differences in the incidence of postoperative pulmonary infection,postoperative anastomotic leakage and stenosis,hospitalization time and TNM staging between the two groups(P>0.05).Conclusion Reverse-puncture anastomosis by endoscopic Ivor-Lewis operation is safe and feasible in the treatment of middle and lower esophageal cancer located in middle and lower arch of azygos vein.

关 键 词：食管中下段癌 胸内反穿刺吻合 IVOR-LEWIS手术 

分 类 号：R735.1[医药卫生—肿瘤]