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目的:探讨食道癌贲门癌术后两种重建方法的优劣。方法:实验组食管癌贲门癌切除术后采用圆形吻合器行食管胃器械吻合,吻合口4号丝线间断加强并另行吻合口大网膜缠绕并吻合合口减张。对照组行食管胃粘膜及粘膜下分层吻合加胃浆肌层与食管肌层缝合包埋吻合口并减张重建。比较两组手术时间,术后肺部感染和肺不张、吻合口瘘和狭窄及胃食管反流发生率。结果:实验组吻合口瘘发生率为0.6%(2/316),吻合口狭窄发生率为5.7%(18/316),对照组吻合口瘘发生率为1.6%(3/186),吻合口狭窄发生率为4.3%(8/186),均有显著性差异(P<0.05)。吻合口近端胃食管反流液随机抽样检查pH值,差异无统计学意义(P>0.05)。行机械吻合手术时间明显缩短,有统计学意义(P<0.05)。实验组肺部感染发生率0.3%(1/316),无肺不张,对照组肺部感染发生率1.6%(3/186),肺不张0.5%(1/186),其差异有统计学意义(P<0.05)。结论:食管癌贲门癌切除术中行机械吻合重建方便快捷,可减少并发症,适于临床临床推广。
Objective: To investigate the advantages and disadvantages of two reconstruction methods for esophageal and gastric cardia cancer patients. Methods: After esophagectomy and cardia cancer resection in the experimental group, a circular stapler was used to perform esophagogastric anastomosis. Anastomotic cleft wire No.4 was intermittently strengthened and another anastomotic omentum was wound and anastomosed to reduce anastomosis. In the control group, esophageal mucosa and submucosal stratified anastomosis plus gastric myometrium and esophageal muscle suture were stitched and anastomosed and rebuilt. The operation time, postoperative pulmonary infection and atelectasis, anastomotic fistula and stenosis and incidence of gastroesophageal reflux were compared between the two groups. Results: The incidence of anastomotic fistula in experimental group was 0.6% (2/316), the incidence of anastomotic stenosis was 5.7% (18/316), and the incidence of anastomotic fistula in control group was 1.6% (3/186) The prevalence of stenosis was 4.3% (8/186), both of which were significantly different (P <0.05). Anastomotic proximal gastroesophageal reflux fluid pH value of random sampling, the difference was not statistically significant (P> 0.05). Line mechanical anastomosis surgery time was significantly shorter, with statistical significance (P <0.05). The incidence of pulmonary infection in the experimental group was 0.3% (1/316), without atelectasis, the incidence of pulmonary infection in the control group was 1.6% (3/186) and atelectasis 0.5% (1/186), the difference was statistically Significance (P <0.05). Conclusion: It is convenient and quick to reconstruct the esophageal and gastric cardia resection in mechanical anastomosis, which can reduce the complications and is suitable for clinical clinical popularization.