食管分层离断法在腹腔镜辅助食管胃结合部癌手术中的应用  

Application of Esophagus Transection in Layers in Laparoscopic-assisted Radical Resection for Esophagogastric Junction Carcinoma

作　　者：张勇超 赵明海 任晋军 李柳 张永磊 Zhang Yongchao;Zhao Minghai;Ren Jinjun(Department of General Surgery, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou 450008, China)

机构地区：[1]郑州大学附属肿瘤医院河南省肿瘤医院普外科,郑州450008

出　　处：《中国微创外科杂志》2021年第3期205-209,共5页Chinese Journal of Minimally Invasive Surgery

基　　金：河南省留学人员科技活动项目择优资助经费(2017-9)。

摘　　要：目的探讨食管分层离断法在腹腔镜辅助食管胃结合部癌手术中应用的可行性及安全性。方法回顾性分析2016年5月~2019年11月422例食管胃结合部癌行腹腔镜辅助根治性全胃切除术的临床资料,2018年2月前203例采用常规方法吻合(传统组),之后219例采用食管分层离断法进行食管空肠吻合(分层组)。比较2组手术时间、食管离断及抵钉座放置时间、术后吻合口并发症发生率及术后住院时间等指标。结果2组手术均顺利完成,均随访1年。分层组术后吻合口并发症发生率[0.5%(1/219)]低于传统组[5.9%(12/203)](χ2=10.499,P=0.001)。2组手术时间、食管离断及抵钉座放置时间、术中出血量、术后首次排气时间、开始进食流质饮食时间、术后住院时间差异均无统计学意义(P>0.05)。结论在腹腔镜辅助食管胃结合部癌手术中应用食管分层离断法行食管空肠吻合,可明显降低术后吻合口并发症的发生,临床效果满意。Objective To explore the feasibility and safety of esophagus transection in layers in laparoscopic-assisted radical resection for esophagogastric junction carcinoma.Methods A retrospective analysis was performed on the clinical data of 422 patients with esophagogastric junction carcinoma who underwent laparoscopic-assisted radical total gastrectomy in our hospital between May 2016 and November 2019.Esophagojejunostomy was performed by routine method in 203 cases before February 2018(traditional group),after that,esophagus transection in layers for anastomosis was used in 219 cases(layering group).Data analysis included operating time,time of esophagus transection and anvil placement,the incidence of postoperative anastomotic complications,postoperative hospitalization time,and so on.Results Laparoscopic-assisted radical resection for esophagogastric junction carcinoma was successfully performed in all the patients.All of them were followed up for 1 year.The incidence of postoperative anastomotic complications in layering group[0.5%(1/219)]was significantly lower than that in traditional group[5.9%(12/203),χ2=10.499,P=0.001].There were no statistically significant differences between the two groups in operation time,time of esophagus transection and anvil placement,intraoperative blood loss,time to first flatus postoperatively,time for initial fluid diet intake postoperatively,postoperative hospitalization time(P>0.05).Conclusion The application of esophagus transection in layers in laparoscopic-assisted radical resection for esophagogastric junction carcinoma can obviously decrease the occurrence of postoperative anastomotic complications with satisfactory clinical results.

关 键 词：食管胃结合部癌 腹腔镜 食管分层离断 食管空肠吻合术 

分 类 号：R73[医药卫生—肿瘤]