经口置入钉砧头系统在食管胃结合部癌复发及再发癌患者手术中的应用  

Application of OrVil^(TM) in patients with recurrent or denovo esophagogastric junction cancer

作　　者：张俊立 刘晨宇 李森 曹养辉 马鹏飞 张习杰 李振豫 李长征 赵玉洲 Zhang Junli;Liu Chenyu;Li Sen;Cao Yanghui;Ma Pengfei;Zhang Xijie;Li Zhenyu;Li Changzheng;Zhao Yuzhou(Department of General Surgery,Affiliated Tumor Hospital,Zhenzhou University(He'nan Tumor Hospital),Zhenzhou 450000,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450000

出　　处：《中华普通外科杂志》2023年第4期258-262,共5页Chinese Journal of General Surgery

摘　　要：目的:探讨经口置入钉砧头系统(OrVil TM)在食管胃结合部癌复发及再发癌患者手术中的应用效果。 方法:回顾性分析2011年1月至2021年6月期间于郑州大学附属肿瘤医院接受食管胃结合部腺癌术后局部复发或再发癌根治术共60例患者的临床资料,依据术中是否使用经口置入钉砧头系统分为2组:26例患者术中应用经口置入钉砧头系统者为研究组,34例患者术中未使用经口置入钉砧头系统为对照组。结果:研究组门齿距离为36(34~40)cm,短于对照组的39(36~41)cm,差异具有统计学意义( Z=-4.948, P<0.05);研究组中位手术时间为177(145~260)min,对照组为172(140~225)min( Z=-0.735, P=0.463);研究组术中中位出血量为200(100~900)ml,对照组为300(100~800)ml( Z=-1.244, P=0.213)。术后研究组上切缘距离为(3.6±1.7)cm,对照组为(1.8±1.1)cm,差异具有统计学意义( t=-0.735, P<0.01);研究组患者的切缘阳性率为4%,低于对照组的15%,但两组差异无统计学意义( χ^(2)=1.931, P=0.165)。研究组术后住院时间为(18.6±5.2)d,对照组为(20.5±4.7)d,差异无统计学意义( t=-1.455, P=0.151)。研究组患者术后出现手术相关并发症发生率为19%,对照组为27%,差异无统计学意义( P>0.05)。 结论:经口置入钉砧头系统应用于食管胃结合部癌术后局部复发或再发癌患者可以减少手术难度,降低切缘阳性率。Objective To investigate the effect of transorally inserted anvil(OrVil^(TM))in patients with relapsed or denovo carcinoma at the esophagogastric junction.Methods The clinical data of 60 patients who underwent radical intent resection for locally relapsed or denovo esophagogastric junction adenocarcinoma at Zhengzhou University Cancer Hospital from Jan 2011 to Jun 2021 were retrospectively analyzed.The patients were divided into two groups according to whether transorally inserted anvil was used.Twenty-six patients who had used the system were assigned to the experimental group.Thirty-four patients without transorally inserted anvil were set to control group.Results The incisor distance of the experimental group was shorter than that of the control group[36(34-40)cm vs.39(36-41)cm,Z=-4.948,P<0.05].Operation time in experimental group was 177(145-260)min,compared to control group of 172(140-225)min(Z=-0.735,P=0.463).Intraoperative blood loss was 200(100-900)ml in the experimental group and 300(100-800)ml in the control group(Z=-1.244,P=0.213).Postoperative upper margin distance of the experimental group was(3.6±1.7)cm compared to control group of(1.8±1.1)cm(t=-0.735,P<0.01).The positive rate of margin in the experimental group was 4%vs.15%in the control group(χ^(2)=1.931,P=0.165).The length of postoperative hospital stay in the experimental group was(18.6±5.2)d vs.(20.5±4.7)d(t=-1.455,P=0.151).Surgery-related complications developed in 19%in the experimental group vs.27%in the control group(P>0.05).Conclusion The application of the transorally inserted anvil in the operation of patients with locally relapsed or denovo esophagogastric junction cancer after initial operation reduces the difficulty of operation and decreases the positive rate of margin.

关 键 词：胃肿瘤 食管胃结合处 肿瘤复发 局部 

分 类 号：R735[医药卫生—肿瘤]