管状吻合器辅助食管胃嵌套式吻合法预防食管癌术后并发症的临床效果分析  

Clinical efficacy of nested anastomosis assisted by tubular stapler in McKeown resection of esophageal cancer

作　　者：马敏杰[1] 徐上清[1] 韩彪[1] Ma Minjie;Xu Shangqing;Han Biao(Department of Thoracic Surgery,the First Hospital of Lanzhou University,Lanzhou 730000,China)

机构地区：[1]兰州大学第一医院胸外科,730000

出　　处：《中华胸心血管外科杂志》2020年第5期257-262,共6页Chinese Journal of Thoracic and Cardiovascular Surgery

基　　金：甘肃省自然科学基金(1606RJZA129)。

摘　　要：目的对比胸腹腔镜联合食管癌三切口根治术中颈部食管胃常规管状机械吻合与管状吻合器辅助嵌套吻合在预防术后并发症方面的临床效果。方法回顾性分析兰州大学第一医院胸外科2016年1月至2017年8月接受胸腹腔镜联合食管癌三切口手术的患者182例,其中颈部吻合时采取常规管状机械吻合85例,管状吻合器辅助嵌套吻合97例,统计分析术后吻合口瘘、吻合口狭窄、肺部感染、切口感染等并发症的发生率。结果与常规管状机械吻合相比,管状吻合器辅助嵌套吻合组吻合口瘘发生率[0(0/97)对4.7%(4/85)]、肺部感染率[3.1%(3/97)对11.8%(10/85)]、术后胃食管反流[7.2%(7/97)对17.6%(15/85)]、吻合口狭窄[3.1%(3/97)对10.6%(9/85)]、颈部切口感染率[1.0%(1/97)对7.1%(6/85)]、手术吻合时间[(14.69±2.65)min对(20.25±4.31)min]方面具有优势,差异有统计学意义(P<0.05);而心律失常、喉返神经损伤、乳糜胸、吻合口炎等并发症两组差异无统计学意义。结论在食管癌三切口根治术行颈部吻合时,管状吻合器辅助嵌套吻合法可明显降低吻合口瘘、吻合口狭窄、胃食管反流、肺部感染等吻合口相关并发症的发生率,是食管癌手术中食管胃颈部吻合的理想吻合方式。Objective To evaluate the clinical efficacy of traditional tubular mechanical anastomosis versus nested anastomosis assisted by tubular stapler in McKeown resection of esophageal cancer.Methods A total of 182 patients who underwent McKeown resection for esophageal cancer between January 2016 and August 2017 were recruited,including 85 patients in the traditional tubular mechanical anastomosis group and 97 patients in the nested anastomosis assisted by tubular stapler group.The incidence of anastomotic fistula and anastomotic stenosis was observed in 6 months after the operation.Results Compared with the traditional mechanical anastomosis,the incidence of anastomotic fistula in nested anastomosis assisted by tubular stape[0(0/97)vs.4.7%(4/85)],lung infection[3.1%(3/97)vs.11.8%(10/85)],gastroesophageal reflux[7.2%(7/97)vs.17.6%(15/85)],anastomotic stenosis[3.1%(3/97)vs.10.6%(9/85)],the neck incision infection rate[1.0%(1/97)vs.7.1%(6/85)],the operative anastomosis time[(14.69±2.65)min vs.(20.25±4.31)min],the difference was statistically significant(P<0.05).There was no significant difference in arrhythmia,recurrent laryngeal nerve injury,chylothorax and anastomosis between the two groups.Conclusion The incidence of complications such as anastomotic fistula,anastomotic stricture,gastroesophageal reflux,and pulmonary infection can be significantly reduced by nested anastomosis assisted by tubular stapler,which is an ideal choice for cervical anastomosis in McKeown resection of esophageal cancer.

关 键 词：管状吻合器 嵌套式吻合 食管癌 

分 类 号：R735[医药卫生—肿瘤]