食管鳞癌近端食管发生扩张时不同胸内吻合策略654例的回顾性队列研究  

Different intrathoracic anastomotic strategies for proximal esophageal dilatation in 654 patients with esophageal:A retrospective cohort study

作　　者：王昱程 卓泽国 仲夏 赵永生[1] 林一丹[1] WANG Yucheng;ZHUO Zeguo;ZHONG Xia;ZHAO Yongsheng;LIN Yidan(Department of Thoracic Surgery,West China Hospital,Sichuan University,Chengdu,610041,P.R.China;Department of Breast Surgery,The First Afiliated Hospital of Zhejiang University School of Medicine,Hangzhou,310030,P.R.China)

机构地区：[1]四川大学华西医院胸外科,成都610041 [2]浙江大学医学院附属第一医院乳腺外科,杭州310030

出　　处：《中国胸心血管外科临床杂志》2024年第5期710-717,共8页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：国家自然科学基金(81672291)。

摘　　要：目的 探讨食管鳞癌患者近端食管发生不同程度扩张时胸内吻合策略。方法 回顾性分析2014年—2017年在华西医院行食管切除术患者的临床资料。根据食管黏膜相直径将患者分为两组:直径≥17.9 mm为显著扩张组,直径<17.9 mm为非显著扩张组;按吻合方法将患者分为手工分层吻合组和机械吻合组。通过倾向性评分匹配调整潜在的混杂因素,采用Masson染色评估食管壁的胶原纤维含量。结果 最终纳入654例,手工分层吻合组206例,其中男158例、女48例,平均年龄(62.21±7.72)岁;机械吻合组448例,其中男377例、女71例,平均年龄(62.57±8.42)岁。与手工分层吻合相比,食管显著扩张患者吻合器组的吻合口瘘发生率更高(原始队列:3.8% vs. 10.7%,P=0.093;倾向性评分匹配队列:1.4% vs. 15.3%,P=0.004),在非显著扩张患者中二者吻合口瘘的发生率差异无统计学意义(原始队列:4.7% vs. 4.2%,P=0.206;倾向性评分匹配队列:4.8% vs. 4.0%,P=0.830)。显著扩张组食管平均胶原纤维面积低于非显著扩张组(P=0.045)。结论 近端食管腔内黏膜直径≥17.9 mm食管鳞癌患者食管壁组织中的胶原纤维含量明显降低。在此种情况下,采用胸内手工分层吻合可以有效降低术后吻合口瘘发生率。Objective To explore the strategy of intrathoracic anastomosis in patients with esophageal squamous cell carcinoma when the proximal esophagus is dilated to different degrees and explore its mechanism.Methods We retrospectively reviewed the clinical data of patients who underwent esophagectomy between 2014 and 2017 in West China Hospital.The patients were divided into two groups including a significant dilatation group with inner mucosal phase diameter(IMPD)≥17.9 mm and a non-significant dilatation group with IMPD<17.9 mm.And the patients were divided into two groups(a layered manual anastomosis group and a stapled anastomosis group)according to anastomosis method and propensity score matching was applied to adjust for potential confounders.Results We finally included 654 patients.There were 206 patients with 158 males and 48 females at average age of 62.21±7.72 years in the layerd manual analstomosis group and 448 patietns with 377 males and 71 females at average age of 62.57±8.42 years in the stapled anastomosis group.We also used Masson trichrome staining to assess the collagen fiber content in the esophagus.Compared with layered manual anastomosis,the incidence of anastomotic leakage was higher in the significant dilatation group than that in the stapled anastomosis group(original cohort:3.8%vs.10.7%,P=0.093;propensity score-matched cohort:1.4%vs.15.3%,P=0.004).And there was no significant difference in anastomotic leakage b etween layered manual anastomosis and stapled anastomosis in the non-significant dilatation group(original cohort:4.7%vs.4.2%,P=0.830;propensity score-matched cohort:4.8%vs.4.0%,P-0.206).Moreover,the average collagen fiber area ratio was significantly lower in the significant dilation group than that in the non-significant dilatation group(P=0.045).ConclusionThere is a significant reduction in collagen fibers in the proximal esophageal wall tissue of esophageal squamous cell carcinoma patients with a IMPD≥17.9 mm.Intrathoracic layered manual anastomosis effectively reduces postopera

关 键 词：食管癌 吻合口瘘 食管直径 风险评估 吻合策略 

分 类 号：R735.1[医药卫生—肿瘤]