下咽-颈段食管癌术后3种缺损修复方法的并发症比较  

Complications of esophageal defect repair after surgery for hypopharyngeal-cervical esophageal cancer:a comparison among three options

作　　者：姜明 何筱天 吴多光[2] 敖翔 李洪胜 Jiang Ming;He Xiaotian;Wu Duoguang;Ao Xiang;Li Hongsheng(Department of Thoracic Surgery,Cancer Hospital Affiliated to Guangzhou Medical University,Guangzhou 510095,China;Department of Thoracic Surgery,Sun Yat-sen Memorial Hospital Affiliated to Sun Yat-sen University,Guangzhou 510120,China)

机构地区：[1]广州医科大学附属肿瘤医院胸外科,510095 [2]中山大学附属孙逸仙纪念医院胸外科,广州510120

出　　处：《中华生物医学工程杂志》2020年第1期62-66,共5页Chinese Journal of Biomedical Engineering

基　　金：广州市医学重点学科建设项目;广州医科大学临床重点专科(202005)。

摘　　要：目的比较下咽-颈段食管癌术后3种食管缺损修复方法的术后短期并发症发生情况。方法回顾性分析2003年1月至2013年2月中山大学孙逸仙纪念医院收治的下咽-颈段食管癌患者105例的临床资料,按食管缺损修复手术方式的不同分为3组:转移皮瓣修复术式为A组(n=45),全胃代食管修复术式为B组(n=32),管状胃代食管修复术式为C组(n=28)。记录3组患者术后并发症发生情况,包括肺部并发症、心律失常、胸胃综合征、切口感染、颈部肿胀、食管反流、吻合口漏、自动出院或死亡等。结果3组心律失常、胸胃综合征、切口感染、颈部肿胀、食管反流、吻合口漏等术后并发症发生率差异有统计学意义(均P<0.05)。3组组间两两比较显示,与A组比较,B组颈部肿胀、吻合口漏发生率较低,而心律失常、胸胃综合征及食管反流发生率较高;与A组比较,C组颈部肿胀、切口感染及吻合口漏发生率较低;与B组比较,C组心律失常、胸胃综合征、食管反流及吻合口漏发生率较低(均P<0.05);其他术后并症发生率组间两两比较,差异均无统计学意义(均P>0.05)。结论3种术后食管缺损修复方法中,管状胃代食管修复术式的安全性最高,且并发症发生率最低。Objective To compare the short-term complications of three esophageal defect repair options after surgery for hypopharyngeal-neck esophageal cancer.Methods The clinical data of 105 patients with hypopharyngeal-cervical esophageal cancer admitted to Sun Yat-sen Memorial Hospital of Sun Yat-sen University between January 2003 and February 2013 were retrospectively analyzed.The subjects were divided into 3 groups according to the options of esophageal defect repair:group A repaired with free flap(n=45),group B with gastric pull-up(n=32),and group C with elongated stomach roll(n=28).Postoperative complications,including pulmonary complications,arrhythmia,thoracogastric syndrome,wound infection,neck swelling,esophageal reflux,anastomotic leakage,patient-determined discharge,and death were recorded and compared among the three groups.Results The three groups differed significantly in incidence rates of postoperative complications including arrhythmia,thoracogastric syndrome,wound infection,neck swelling,esophageal reflux,and anastomotic leakage(all P<0.05).By pairwise comparison among groups,group B experience less neck swelling and anastomotic leakage but more arrhythmia,thoracogastric syndrome and esophageal reflux compared with group A;group C experienced less neck swelling,wound infection,and anastomotic leakage compared with group A,and less arrhythmia,thoracogastric syndrome,esophageal reflux,and anastomotic leakage compared with group B(all P<0.05).There were no significant differences in the incidence of the rest postoperative complications between the any two groups(all P>0.05).Conclusion Among the three options of postoperative esophageal defect repair,elongated stomach roll offers the highest safety and the lowest complication rate.

关 键 词：食管肿瘤 修复外科手术 手术后并发症 

分 类 号：R735[医药卫生—肿瘤]