食管胃颈部改良全机械侧侧吻合在食管癌手术中的应用

发布时间：2018-05-27 22:20

本文选题：食管癌 + 侧侧顿合　；参考：《福建中医药大学》2016年硕士论文

【摘要】：【目的】比较食管胃颈部改良全机械侧侧吻合和圆形吻合器吻合对食管癌术后吻合口瘘、良性吻合口狭窄、反流性食管炎等主要并发症的影响。【方法】采用随机对照研究方法,按入院顺序,将2014年1月至2015年6月期间共109例可行手术治疗的胸中、下段食管癌患者随机分为食管胃颈部改良全机械侧侧吻合组（SSSA组)和食管胃颈部圆形吻合器吻合组(CSA组)。分别观察对比两组患者术中吻合时间、住院期间死亡率及术后并发症的差异,主要是吻合口瘘、良性吻合口狭窄及反流性食管炎的发生情况。【结果】两组患者的一般临床资料差异无统计学意义(P0.05)。两组患者在病理分期、肿瘤位置、术前辅助放化疗情况、术前基础疾病情况及手术方式(开放McKeowi食管癌根治术或微创McKeown食管癌根治术)上之间差异无统计学意义(P0.05)。两组患者术中均达到R0切除,术后病理证实上下切端均为阴性。术中吻合时间、住院期间死亡率、肺部并发症、心血管并发症等方面差异均无统计学意义(P0.05)。SSSA组与CSA组术后吻合口瘘发生率分别为:3.9%(2/51)和8.6%(5/58)(P=0.544)。根据Visick评分,SSSA组反流性食管炎的发生率为34.7%(17/49),与CSA组47.3%(26/55)相比较低,但差异无统计学意义(P=0.210)。术后1周、1月、3月改良全机械侧侧吻合口面积分别为2.31(1.58,3.54)cm2、2.16(1.43,3.38)cm~2、2.06(0.29,2.60)cm2,与圆形吻合器组同期相比较大,差异均有统计学意义。SSSA组与CSA组术后吻合口狭窄发生率分别为2.1%(1/47)和18.5%(10/54),差异有统计学意义(P=0.010)。【结论】食管胃颈部改良全机械侧侧吻合术是一种安全、有效、可行的吻合方式,可以减少术后吻合口良性狭窄的发生。
[Abstract]:[objective] to compare the effect of modified total mechanical lateral anastomosis and circular stapler anastomosis on anastomotic leakage and stenosis of benign anastomosis in patients with esophageal carcinoma after operation. Effects of major complications such as reflux esophagitis. [methods] A randomized controlled study was conducted in 109 patients with operable esophagitis from January 2014 to June 2015. Patients with lower esophageal carcinoma were randomly divided into two groups: modified total mechanical lateral anastomosis (SSSA group) and circular anastomosis group (CSA group). The difference of anastomosis time, mortality during hospitalization and postoperative complications between the two groups were observed and compared respectively, mainly anastomotic leakage. The incidence of benign anastomotic stenosis and reflux esophagitis. [results] there was no significant difference in general clinical data between the two groups (P 0.05). There was no significant difference between the two groups in pathological staging, tumor location, preoperative adjuvant radiotherapy and chemotherapy, preoperative underlying diseases and surgical methods (open radical resection of McKeowi esophageal carcinoma or minimally invasive McKeown radical resection of esophageal carcinoma). All the patients in both groups achieved R 0 resection during operation, and the upper and lower incisors were negative by pathology after operation. There was no significant difference in anastomotic time, mortality during hospitalization, pulmonary complications and cardiovascular complications between the SSSA group and the CSA group. The incidence of anastomotic fistula in the SSSA group and the CSA group was 2 / 51 and 8. 6% / 58 respectively. According to the Visick score, the incidence of reflux esophagitis in the SSSA group was 34.7 / 49, which was lower than that in the CSA group (47.3 / 26 / 55), but there was no significant difference between the two groups. At 1 week, 1 month and 3 months after operation, the area of modified total mechanical side anastomosis was 2.31 ~ 1.58 ~ 3.54 ~ (cm ~ (2) ~ 2.16 ~ 1.43 ~ 3.38 ~ 3.38 ~ (cm ~ (-1) ~ 0.29 ~ 2.60 cm ~ (2), respectively, which was larger than that of round stapler group in the same period. The incidence of anastomotic stenosis in SSSA group and CSA group was 2.1 / 47 and 18.510 / 54, respectively, and the difference was statistically significant. [conclusion] modified total mechanical lateral anastomosis of esophagus and stomach is a safe, effective and feasible anastomosis. It can reduce the occurrence of benign stenosis of anastomosis after operation.
【学位授予单位】：福建中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R735.1

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