吻合器吻合与手工舌状浆肌瓣覆盖吻合在食管癌颈部吻合术中的应用对比

发布时间：2018-01-12 12:07

  本文关键词：吻合器吻合与手工舌状浆肌瓣覆盖吻合在食管癌颈部吻合术中的应用对比　出处：《新乡医学院》2015年硕士论文　论文类型：学位论文

  更多相关文章： 食管癌 吻合器 手工吻合 并发症

【摘要】：背景食管癌(Esophageal cancer, EC)是人类常见的恶性肿瘤之一,在发展中国家表现出高发病率和高死亡率两大特征。EC的发病率呈明显的地区性分布差异,我国华北太行山区的河南省林州和河北省磁县均属于食管癌高发区。目前,外科手术仍是EC治疗的主要手段。由于EC存在多点起源,癌灶散在、互不连续的特点,因此,尽量切除较多的食管是手术治疗EC的基本要求之一。由于食管胃颈部吻合术能切除较多的食管,最大程度降低吻合口的局部复发率,因而是治疗EC广泛采用的手术方式。但是,食管胃颈部吻合术的并发症发生率高,主要包括吻合口瘘和吻合口狭窄。为减少颈部吻合口瘘等并发症的发生率,不同医院采取了多种吻合方法,如隧道式吻合、全层吻合、侧侧吻合、机械吻合等。目前我院食管胃颈部吻合主要有圆形吻合器吻合和手工舌状浆肌瓣覆盖食管胃吻合两种吻合方式。为比较两种吻合方式的优劣,本研究比较了分别接受吻合器吻合(99例)、舌状浆肌瓣覆盖食管胃吻合(90例)手术EC患者的手术时间、住院时间、手术住院费用、吻合口瘘例数及程度、吻合口狭窄例数及程度、食管反流程度等,为食管癌颈部吻合术采取何种方式吻合,提供参考依据。目的探讨在食管癌颈部吻合术中,吻合器吻合与手工舌状浆肌瓣覆盖吻合的手术效果及并发症发生情况,确定个体化食管癌颈部吻合术判定标准,提高手术效率,减少并发症的发生。方法选择189例食管癌手术患者,经左开胸实施双野淋巴结清扫及食管管状胃颈部吻合术,其中吻合器吻合99例,舌状浆肌瓣覆盖食管胃吻合90例,两组患者术后病理上下切缘均为阴性。比较分析两种吻合术式的手术时间、术中出血、住院时间、手术住院费用、吻合口瘘例数及程度、吻合口狭窄例数及程度、食管反流程度等参数,确定两种术式的利弊。结果1.吻合器吻合组99例患者4例(4.0%,n=99)发生吻合口瘘,舌状浆肌瓣覆盖吻合组90例患者中11例(12.2%,n=90)发生吻合口瘘,吻合器组与舌状浆肌瓣覆盖组吻合口瘘发生率的差异有统计学意义(P0.05,χ2=4.32)。2.吻合器组中7例(7.1%,n=99)发生吻合口狭窄,舌状浆肌瓣覆盖食管胃吻合组中8例(8.9%,n=90)发生吻合口狭窄。两组吻合口狭窄发生率的差异无统计学意义(P0.05,χ2=0.24)。3.吻合器组中35例(35.4%,n=99)发生反流性食管炎,舌状浆肌瓣覆盖食管胃吻合组中21例(21.1%,n=90)发生反流性食管炎,两组发生反流性食管炎的差异有统计学意义(P0.05,χ2=4.69)。4.吻合器组平均住院费用(13356.8±60.7元)显著高于舌状浆肌瓣覆盖吻合组平均住院费用(12147.6±62.5元),两组差异有统计学意义(P0.01,t=134.86)。5.吻合器组平均住院天数(19±1.5d)低于舌状浆肌瓣覆盖吻合组(21±1.8d),两组差异有统计学意义(P0.01,t=8.33)。6.吻合器组平均手术时间(181.3±5.7min)和舌状浆肌瓣覆盖吻合组平均手术时间(180.6±6.2min)比较无统计学差异(P0.05,t=0.81)。7.吻合器组平均术中出血量(239±76m1)和舌状浆肌瓣覆盖吻合组平均术中出血量(242±72m1)比较无统计学差异(P0.05,t=0.28)。结论在颈部食管管状胃的两种吻合术式中,圆形吻合器吻合术操作简单,初学者容易掌握,术后吻合口瘘发生率低,住院时间短,但其术后返流发生率高,增加住院费用；舌状浆肌瓣覆盖食管胃吻合术吻合口瘘发生率高,住院时间长,但其术后抗返流效果好,可减少住院费用。两者手术时间和出血量无区别。两种吻合方式各有利弊,在临床工作中可根据患者病情、经济及身体状况确定最佳手术方式。
[Abstract]:Background: esophageal cancer (Esophageal cancer EC) is one of the most common malignant tumors, the incidence of high morbidity and mortality rate of.EC was two characteristics of regional distribution differences showed in the developing world, North China's Henan province in Linzhou Taihang Mountain Area in Hebei province and Cixian belong to the high incidence area of esophageal cancer. At present. The main means of surgery is still the treatment of EC. Because the EC has multiple origins, foci scattered in discrete characteristics, therefore, as more resection is one of the basic requirements of esophageal surgery in the treatment of EC. Because of cervical esophagogastrostomy in esophageal resection surgery can be more, to minimize the local recurrence rate of anastomosis thus, operation is widely used in the treatment of EC. However, cervical esophagogastrostomy in the high incidence of complications, including anastomotic leakage and stenosis. To reduce cervical anastomotic fistula and other complications The incidence of different hospitals adopted various methods such as anastomosis, tunnel anastomosis, full-thickness anastomosis anastomosis, mechanical anastomosis in our hospital. The cervical esophagogastrostomy is circular stapling and hand shaped seromuscular flap covering two anastomosis of esophagogastric anastomosis. For comparing the two modes., this study compares the received anastomosis (99 cases), tongue seromuscular flap coverage of esophagogastric anastomosis (90 cases) EC surgical operation time, hospitalization time, hospitalization costs of surgery, anastomotic fistula cases and anastomotic stenosis degree, the number of cases and the degree of esophageal reflux degree, esophageal what way cancer neck anastomosis anastomosis, to provide the reference. Objective to investigate the neck anastomosis in esophageal cancer, surgical effect and complications of stapling anastomosis and manual tongue seromuscular flap covered the incidence of certain individual cervical esophageal carcinoma Criteria of anastomosis, improve operation efficiency, reduce the incidence of complications. Methods 189 patients with carcinoma of esophagus through left thoracotomy of two field lymphadenectomy and esophageal gastric tube neck anastomosis, the anastomosis in 99 cases, ligulate pulp muscle flap of esophagogastric anastomosis in 90 cases, two groups of patients with postoperative pathological conditions the margins were negative. The comparative analysis of two kinds of anastomosis operation time, intraoperative bleeding, hospitalization time, hospitalization costs of surgery, anastomotic fistula cases and anastomotic stenosis degree, the number of cases and the degree of esophageal reflux degree and other parameters to determine the advantages and disadvantages of the two kinds of surgical anastomosis. Results of 1. groups of 99 in 4 patients (4%, n=99) of anastomotic fistula, tongue flap seromuscular anastomosis group 90 patients in 11 cases (12.2%, n=90) of anastomotic fistula, stapler group and tongue seromuscular flap coverage group anastomotic fistula rate difference was statistically significant (P0.05, 蠂2=4.32).2.鍚诲悎鍣ㄧ粍涓，

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