幽门成形术在微创Mckeown食管癌切除术中的应用疗效分析  

Efficacy of minimally invasive Mckeown esophagectomy with pyloroplasty

作　　者：孙云浩 黄利荣 应开军 王尧 季明明 卞文 陈岑 陈津津 SUN Yunhao;HUANG Lirong;YING Kaijun;WANG Yao;JI Mingming;BIAN Wen;CHEN Cen;CHEN Jinjin(Department of Thoracic Surgery,The Yancheng Clinical College of Xuzhou Medical University,The First People's Hospital of Yancheng,Yancheng 224001,Jiangsu Province,China;Department of Oncology,The Yancheng Clinical College of Xuzhou Medical University,The First people's Hospital of Yancheng,Yancheng 224001,Jiangsu Province,China)

机构地区：[1]盐城市第一人民医院(徐州医科大学盐城临床学院)胸外科,江苏盐城224001 [2]盐城市第一人民医院(徐州医科大学盐城临床学院)肿瘤科,江苏盐城224001

出　　处：《同济大学学报（医学版）》2023年第6期817-823,共7页Journal of Tongji University(Medical Science)

基　　金：江苏省盐城市医学科技发展计划项目(YK2020015);江苏省卫生健康委科研项目(Z2022062);吴阶平医学基金会临床科研专项资助基金(3206750.2022-10-12)。

摘　　要：目的分析微创Mckeown食管癌切除术联合幽门成形术的术后近期应用疗效。方法回顾性分析2021年4月—2022年11月盐城市第一人民医院127例接受微创食管癌根治术加幽门成形术患者的临床资料(治疗组),并与同期135例未联合幽门成形术的患者资料(对照组)进行对比,比较两组间的临床疗效差异。结果治疗组术后吻合口瘘少于对照组,差异有统计学意义(P<0.05),治疗组手术时间略长于对照组。多因素Logistic回归分析显示合并糖尿病、手术方式、术后低蛋白血症、肺部感染是影响术后吻合口瘘的风险因素。治疗组胃食管反流、胃排空障碍数低于对照组,差异有统计学意义(P<0.05)。治疗组术后营养状态优于对照组,且术后躯体功能、社会功能、情绪功能、整体健康较对照组明显改善,差异有统计学意义(P<0.05)。结论微创Mckeown食管癌切除术联合幽门成形术可减少术后吻合口瘘,降低术后胃排空障碍、胃食管反流的发生,改善术后营养状况,且可提高术后生存质量。Objective To analyze the short-term postoperative efficacy of minimally invasive Mckeown esophagectomy with pyloroplasty.Methods The clinical data of 127 patients who received minimally invasive Mckeown esophagectomy plus pyloroplasty in our hospital from April 2021 to November 2022(study group),and 135 patients who received esophagectomy only during the same period(control group)were retrospectively analyzed and the clinical efficacy was compared between the two groups.Results The incidence of postoperative anastomotic leakage in the study group was less than that in the control group(P<0.05).Multivariate logistic regression analysis showed that diabetes mellitus,operation method,postoperative hypoproteinemia and pulmonary infections were risk factors of postoperative anastomotic leak.The number of gastroesophageal reflux and delayed gastric emptying in the study group was lower than that in the control group(P<0.05).The postoperative nutritional status,the postoperative physical function,social function,emotional function and overall health quality in the study group were significantly better than those in the control group(all P<0.05).Conclusion Minimally invasive Mckeown esophagectomy combined with pyloroplasty can reduce postoperative anastomotic leakage,postoperative delayed gastric emptying and gastroesophageal reflux,improve postoperative nutritional status,and enhance long-term quality of life of patients.

关 键 词：微创Mckeown食管癌切除术 幽门成形术 胃食管反流 胃排空障碍 吻合口瘘 

分 类 号：R655.4[医药卫生—外科学]