【摘要】 目的探讨一种新的食管-胃颈部吻合方法在胸、腹腔镜联合下食管癌根治术中的应用价值。方法 2014年10月~2016年1月我中心完成232例胸、腹腔镜联合下食管癌根治术。根据不同的颈部吻合方式分为2组:新式吻合组(颈部端端-侧侧-套入式吻合)68例,传统吻合组(以圆形吻合器做颈部端-侧吻合)164例,2组患者均采用胸、腹腔镜联合切口,胃-食管颈部吻合,仅颈部吻合方式不同。比较2组主要并发症(吻合口漏、吻合口瘢痕狭窄、胃食管返流)、手术时间、术中出血量、术后住院时间等情况。结果 2组手术时间分别为(223.5±42.4)、(213.7±39.8)min,无统计学差异(t=1.675,P=0.095);术中出血量分别为(83.4±24.2)、(87.6±27.3)ml,无统计学差异(t=-1.102,P=0.272);术后住院时间分别为(12.2±3.5)、(12.8±6.0)d,无统计学差异(t=-0.771,P=0.441);吻合口漏发生率分别为1.5%(1/68)、8.5%(14/164),无统计学差异(χ2=2.886,P=0.089);新式吻合组吻合口狭窄发生率1.5%(1/68),明显低于传统吻合组12.2%(20/164)(χ2=6.716,P=0.010);新式吻合组胃食管返流发生率5.9%(4/68),明显低于传统吻合组18.3%(30/164)(χ2=5.919,P=0.015)。结论端端-侧侧-套入式吻合技术安全、可行,吻合口常见并发症(吻合口狭窄、消化液返流)发生率低,值得临床进一步推广。更多还原

【Abstract】 Objective To discuss the application value of a new method of esophagogastric cervical anastomosis in esophageal cancer radical surgery under thoracoscopy and laparoscopy. Methods A total of 232 cases of radical resection of esophageal cancer under thoracoscopy and laparoscopy from October 2014 to January 2016 were studied. They were divided into two groups according to different methods of anastomosis: the new method group( end to end-side to side-invagination anastomosis,n = 68) and the triditional group( end to side anastomosis by using a circular stapler,n = 164). Both groups of patients were performed by thoracic laparoscopic surgery of esophagogastric cervical anastomosis,only in different anastomosis methods. The postoperative complications,operation time,blood loss,and postoperative hospital stay were compared between the two groups. Results The operation time was not significantly different between the two groups [( 223. 5 ± 42. 4) min vs.( 213. 7 ± 39. 8) min,t = 1. 675,P = 0. 095]. The blood loss was not significantly different between the two groups [( 83. 4 ± 24. 2) ml vs.( 87. 6 ± 27. 3) ml,t =-1. 102,P = 0. 272]. The postoperative hospital stay was not significantly different between the two groups [( 12. 2 ± 3. 5) d vs.( 12. 8 ± 6. 0) d,t =-0. 771,P = 0. 441]. The incidence of anastomotic leakage was 1. 5%( 1/68) in the new method group and 8. 5%( 14/164) in the triditional group,without significant difference( χ2= 2. 886,P = 0. 089). The incidence of anastomosis stenosis was significantly lower in the new method group than that in the triditional group [1. 5%( 1/68) vs. 12. 2%( 20/164),χ2= 6. 716,P = 0. 010]. The incidence of gastroesophageal reflux was significantly lower in the new method group than that in the triditional group [5. 9%( 4/68) vs. 18. 3%( 30/164),χ2= 5. 919,P = 0. 015]. Conclusion The end to end-side to side-invagination anastomosis can prevent the main two complications( anastomosis stenosis and gastroesophageal reflux) of anastomosis effectively,which is worthy of clinical application.更多还原