吻合器常规吻合与“双荷包吻合”对食管癌术后吻合口狭窄的对比分析

发布时间：2018-05-30 04:29

本文选题：食管癌术后 + 吻合口狭窄　；参考：《新乡医学院》2017年硕士论文

【摘要】：背景消化道重建是食管癌外科治疗的重要组成部分,手工吻合胸腔内操作程序复杂,间断缝合组织损伤大,手术时间长,实际吻合操作与手术医师熟练程度密切相关,术后吻合口狭窄、吻合口瘘、消化道出血、吻合口炎发生率较高,增加病人风险。随着经济社会的发展及人们现代生活理念的建立,器械吻合已成为现今各大医院最为普遍的吻合方式,极大减少了吻合口瘘的发生率,而吻合口狭窄越来越成为食管癌术后胸外科医师关注的重要课题,文献报道其发生率为1.8-40.0%,患者吞咽困难,进食受限症状多与术前相仿,降低患者抗病信心,重度狭窄者甚至需反复行胃镜下扩张,增加患者的心理及经济负担,降低患者生活质量。目的探讨改进吻合方式以减少吻合口狭窄的方法,为降低食管癌术后吻合口狭窄发生率提供帮助。方法收集2013年4月到2015年8月在我院接受左开胸食管癌根治术的食管癌患者374例,均在本院行食管癌根治术治疗。将374例患者分为两组,其中常规吻合组:器械吻合时不给予胃壁荷包缝合187例;双荷包吻合组:器械吻合时分别在食管、胃壁行双荷包吻合187例,对比观察两组术后吻合口狭窄发生情况。结果通过统计分析对比,术后双荷包吻合组发生轻度狭窄17例,常规吻合组7例(χ2=4.452,P=0.035),中度狭窄12例比4例(χ2=3.199,P=0.074),重度狭窄9例比3例(χ2=2.152,P=0.142),总狭窄例数38例比14例(χ2=12.866,P=0.000),两组比较差异有统计学意义,双荷包吻合组相对优于常规吻合组。结论双荷包吻合法能够更有效减少术后吻合口狭窄的发生率。
[Abstract]:Background the reconstruction of digestive tract is an important part of the surgical treatment of esophageal carcinoma. The procedure of manual anastomosis in thoracic cavity is complicated, the tissue injury of discontinuous suture is large, the operation time is long, and the actual anastomosis operation is closely related to the skill of the surgeon. The incidence of anastomotic stenosis, anastomotic leakage, gastrointestinal hemorrhage and anastomotic inflammation was higher, which increased the risk of the patients. With the development of economy and society and the establishment of people's modern concept of life, the anastomosis of instruments has become the most common anastomosis in major hospitals, which greatly reduces the incidence of anastomotic fistula. However, anastomotic stenosis has become an important issue for thoracic surgeons after esophageal cancer surgery. The incidence rate of anastomotic stenosis is 1.8-40.0. the patients with dysphagia and eating restriction symptoms are similar to those before surgery, which reduces the patients' confidence in disease resistance. Patients with severe stenosis even need repeated gastroscopic dilatation to increase the psychological and economic burden of patients and reduce the quality of life of patients. Objective to explore the method of improving anastomosis to reduce anastomotic stenosis, and to provide help to reduce the incidence of anastomotic stenosis after esophageal cancer operation. Methods from April 2013 to August 2015, 374 patients with esophageal cancer underwent radical resection of esophageal cancer in our hospital from April 2013 to August 2015. 374 patients were divided into two groups, the routine anastomosis group (n = 187), the double pocket anastomosis group (n = 187), the esophagus anastomosis group (n = 187) and the stomach wall anastomosis group (n = 187). The incidence of anastomotic stenosis in two groups was observed. Results through statistical analysis and comparison, 17 cases of mild stenosis occurred in the group of double pocket anastomosis. There were 7 cases in routine anastomosis group (蠂 2 + 4.452), 12 cases in moderate stenosis compared with 4 cases (蠂 2 / 3.199P < 0.074), 9 cases in severe stenosis than 3 cases (蠂 2 / 2.152 P < 0. 142), and 38 cases in total stenosis compared with 14 cases (蠂 2 12. 86 6 P 0. 000). There was significant difference between the two groups and the double bag anastomosis group was better than that of routine anastomosis group. Conclusion double-pocket anastomosis can reduce the incidence of anastomotic stenosis more effectively.
【学位授予单位】：新乡医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.1

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