食管空肠半端端吻合与侧侧吻合在食管胃结合部腺癌腹腔镜根治性全胃切除术中的临床价值  

Clinical value of semi⁃end⁃to⁃end esophagojejunal anastomosis versus side⁃to⁃side esophagojejunal anastomosis in laparoscopic total gastrectomy for adenocarcinoma of esophagogastric junction

作　　者：熊杰 单治国 杨健 钱锋 石彦 余佩武 赵永亮 Xiong Jie;Shan Zhiguo;Yang Jian;Qian Feng;Shi Yan;Yu Peiwu;Zhao Yongliang(Department of General Surgry,the First Hospital Affiliated to Army Medical University,Chongqing 400038,China)

机构地区：[1]陆军军医大学第一附属医院普通外科,重庆400038

出　　处：《中华消化外科杂志》2020年第11期1190-1195,共6页Chinese Journal of Digestive Surgery

基　　金：国家自然科学基金(81872016);军事医学与战创伤救治临床新技术计划(SWH2016JSTSYB⁃27)。

摘　　要：目的探讨食管空肠半端端吻合与侧侧吻合在食管胃结合部腺癌腹腔镜根治性全胃切除术中的临床价值。方法采用回顾性队列研究方法。收集2016年1月至2019年1月陆军军医大学第一附属医院收治的85例食管胃结合部腺癌患者的临床病理资料;男65例,女20例;年龄为(58±10)岁,年龄范围为36~84岁。85例患者中,46例行腹腔镜全胃切除+D2淋巴结清扫+食管空肠半端端吻合术,设为半端端吻合组;39例行腹腔镜全胃切除+D2淋巴结清扫+食管空肠侧侧吻合术,设为侧侧吻合组。观察指标:(1)手术情况。(2)术后情况。(3)随访情况。采用门诊和电话方式进行随访,了解患者术后1年生存情况、吻合口狭窄及肿瘤复发情况。随访时间截至2020年1月。正态分布的计量资料以x±s表示,组间比较采用t检验。计数资料以绝对数表示,组间比较采用χ2检验或Fisher确切概率法。等级资料比较采用非参数秩和检验。结果(1)手术情况:两组患者均顺利完成腹腔镜全胃切除+D2淋巴结清扫术,无中转开腹及术中死亡情况。半端端吻合组和侧侧吻合组患者肿瘤近切缘距离、食管空肠吻合时间、辅助切口长度分别(2.3±0.9)cm、(32±3)min、(7.5±1.6)cm和(1.6±1.0)cm、(42±5)min、(4.8±1.2)cm,两组比较,差异均有统计学意义(t=3.334,10.177,8.734,P<0.05)。侧侧吻合组1例患者术中行食管空肠吻合时,近端空肠被直线切割吻合器刺穿致空肠破裂,予术中切除破裂段空肠,游离空肠系膜再行食管空肠侧侧吻合。(2)术后情况:半端端吻合组和侧侧吻合组患者术后食管空肠吻合口出血分别为1例和7例,两组比较,差异有统计学意义(χ2=4.449,P<0.05)。术后食管空肠吻合口出血患者均通过输血、内镜下止血等保守治疗好转;术后食管空肠吻合口瘘患者(侧侧吻合组1例)经腹腔穿刺引流、抗感染等保守治疗痊愈;术后十二指肠残端瘘患者(侧侧吻合组2例)经抗�Objective To investigate the clinical value of semi⁃end⁃to⁃end esophagojejunal anastomosis versus side⁃to⁃side esophagojejunal anastomosis in laparoscopic total radical gastrectomy for adenocarcinoma of esophagogastric junction.Methods The retrospective cohort study was conducted.The clinical data of 85 patients with adenocarcinoma of esophagogastric junction who were admitted to the First Hospital Affiliated to Army Medical University from January 2016 to January 2019 were collected.There were 65 males and 20 females,aged(58±10)years,with a range of 36 to 84 years.Of the 85 patients,46 patients undergoing laparoscopic total gastrectomy+D2 lymphadenectomy+semi⁃end⁃to⁃end esophagojejunal anastomosis were allocated into semi⁃end⁃to⁃end anastomosis group,and 39 patients undergoing laparoscopic radical total gastrectomy+D2 lymphadenectomy+side⁃to⁃side esophagojejunal anastomosis were allocated into side⁃to⁃side anastomosis group.Observation indicators:(1)surgical situations;(2)postoperative situations;(3)follow⁃up.Follow⁃up was performed by outpatient examination and telephone interview to detect the survival,anastomotic stenosis and tumor recurrence at postoperative one year up to January 2020.Measurement data with normal distribution were expressed as Mean±SD,and comparison between groups was analyzed using the t test.Count data were expressed as absolute numbers,and comparison between groups was analyzed using the chi⁃square test or Fisher exact probability.Comparison of ranked data was analyzed using the nonparametric rank sum test.Results(1)Surgical situations:patients of two groups successfully underwent laparoscopic total gastrectomy with D2 lymph node dissection,without conversion to open surgery or perioperative death.The proximal length between tumor and surgical margin,time of esophagojejunal anastomosis,length of auxiliary incision were(2.3±0.9)cm,(32±3)minutes,(7.5±1.6)cm for the semi⁃end⁃to⁃end anastomosis group,respectively,versus(1.6±1.0)cm,(42±5)minute

关 键 词：食管胃结合部肿瘤 腹腔镜全胃切除术 Roux⁃en⁃Y吻合术 食管空肠半端端吻合 食管空肠侧侧吻合 腹腔镜检查 

分 类 号：R735[医药卫生—肿瘤]