端端分层吻合加胃底套入包埋在微创食管癌切除术中的应用  

Application of end-to-end double-layer hand-sewn esophagogastric anastomosis and gastric fundus embedding during minimally invasive esophagectomy for esophageal cancer

作　　者：唐波[1] 赵夏[1] 刘红兵[1] 张清峰 刘奎[1] TANG Bo;ZHAO Xia;LIU Hongbing;ZHANG Qingfeng;LIU Kui(Department of Thoracic and Cardiovascular Surgery,Zigong Fourth People’s Hospital,Zigong 643000,Sichuan Province,China)

机构地区：[1]自贡市第四人民医院胸心大血管外科,四川自贡643000

出　　处：《中国癌症杂志》2022年第3期251-257,共7页China Oncology

摘　　要：背景与目的:食管癌术中胃与食管吻合的方式有多种,每种吻合方式各有优缺点。探讨端端分层吻合加胃底套入包埋在微创食管癌切除术中的安全性和实用性。方法:回顾并分析2019年4月—2021年4月在自贡市第四人民医院接受微创食管癌切除术的129例患者的临床病理学资料。全部患者采用胸腹腔镜联合下颈胸腹三切口(McKeown术式)的食管癌切除方法,胸部操作在胸腔镜下完成,腹部操作在腹腔镜下完成。根据吻合方式分为端端分层吻合组(87例)和端侧器械吻合组(42例)。术后随访比较两组的并发症,其中吻合口瘘、吻合口狭窄、胃食管反流是本研究的主要观察目标。结果:129例患者均顺利完成微创食管癌切除手术。端端分层吻合组术前接受新辅助治疗的患者较端侧器械吻合组多(12.0%vs 2.3%,P=0.037),两组患者的其余基本临床资料差异无统计学意义(P>0.05)。两组的平均手术时间无显著差异。端侧器械吻合组的吻合时间少于端端分层吻合组[(32.0±6.8)min vs(15.0±5.4)min,P=0.021]。两组术后并发症中吻合口瘘(1.1%vs 11.9%,P=0.023)、胃食管反流(9.1%vs 26.1%,P=0.012)、肺炎(12.6%vs 30.9%,P=0.023)及心律失常的发生率(10.3%vs 26.1.%,P=0.020)差异均有统计学意义。结论:端端分层吻合加胃底套入包埋在食管癌切除术中安全、可靠,能有效地防止吻合口瘘及胃食管反流症状。Background and purpose:There are many anastomoses between stomach and esophagus in esophageal cancer surgery,each of which has its own advantages and disadvantages.The aim of this study was to investigate the safety and feasibility of end-to-end double-layer esophagogastric anastomosis and gastric fundus embedding during minimally invasive esophagectomy for esophageal cancer.Methods:The clinicopathological data of 129 patients who underwent minimally invasive esophagectomy from April 2019 to April 2021 in Zigong Fourth People’s Hospital were retrospectively reviewed.All patients were treated with thoracoscopy and laparoscopy combined with minimally invasive cervicothoracic and abdominal tri-incision(McKeown procedure)esophageal cancer resection.The thoracic procedure was performed with thoracoscopy,and the abdominal procedure with laparoscopy.The patients were divided into end-to-end double-layer esophagogastric anastomosis and gastric fundus embedding group(87 cases)and end-to-side anastomosis group(42 cases).Patients were followed up for evaluation of associated complications,of which anastomotic leakage,anastomotic stenosis and gastroesophageal reflux were the primary objectives of this study.Results:All the 129 patients underwent esophagectomy.Neoadjuvant therapy was more common in the end-to-end doubled anastomosis group(12.0%vs 2.3%,P=0.037).There was no statistically significant difference in other basic clinical data between the two groups(P>0.05).There was no significant difference in the mean operation time between the two groups.The anastomosis time was less in end-to-side stapling group than in end-to-end stapling group[(32.0±6.8)min vs(15.0±5.4)min,P=0.021].The differences in the incidences of anastomotic leakage (1.1% vs 11.9%, P = 0.023), gastroesophageal reflux (9.1% vs 26.1%, P = 0.012), pneumonia (12.6% vs 30.9%, P = 0.023) and arrhythmia (10.3% vs 26.1.%, P = 0.020) were statistically significant between the two groups. Conclusion: The method of end-to-end double-layer anastomosis and gastr

关 键 词：食管癌 食管切除术 手工吻合 端端分层吻合 胃底套入包埋 

分 类 号：R735.1[医药卫生—肿瘤]