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目的分析带蒂大网膜在老年食管癌术中应用的价值。方法老年食管癌患者214例随机分成带蒂大网膜吻合组(130例)和常规吻合组(84例),带蒂网膜吻合组患者术中游离胃时,保留胃右动脉处网膜宽约4.0~6.0 cm,将带蒂网膜垂帘式包绕食管胃吻合口1周,间断缝合固定,剩余网膜和胃网膜右动脉平铺在食管床,呈半包围状覆盖管胃,防止吻合口及胃小弯侧胃漏。观测两组患者术后胸腔引流量、拔胸管时间、出院时间、吻合口漏、胸胃综合征、心律失常(包括房颤、室上速等)、肺部感染、术后1个月肺功能等指标。结果两组患者均治愈出院,无死亡病例,带蒂网膜吻合组术后吻合口漏与常规组相比,差异有统计学意义(P<0.05),两组患者术后胸腔引流量、拔胸管时间、出院时间、胸胃综合征、心律失常、肺部感染、术后1个月肺功能等指标相比差异无统计学意义(P>0.05)。结论带蒂大网膜垂帘式包绕吻合口、网膜平铺食管床半包匪管胃,可有效降低吻合口漏的发生,有利于老年患者快速康复。
Objective To analyze the value of pedicled omentum in the treatment of elderly esophageal cancer. Methods A total of 214 elderly patients with esophageal cancer were randomly divided into pedicled omentum anastomosis group (n = 130) and conventional anastomosis group (n = 84). The patients with pedicled anastomosis were given intraoperative free stomach, About 4.0 ~ 6.0 cm, the epidural mesh curtain wrapped around the esophagogastric anastomosis for 1 week, interrupted suture, the remaining omentum and the right gastroepiploic aneurysm in the esophageal bed was covered with semi-enveloping tube covering the stomach to prevent Anastomotic and gastric lesser side of the stomach drain. Thoracic drainage, chest pulling time, discharge time, anastomotic leakage, thoracoabdominal syndrome, arrhythmia (including atrial fibrillation, supraventricular tachycardia), pulmonary infection, postoperative 1 month lung Function and other indicators. Results The two groups of patients were cured and discharged without death. The anastomotic leakage in the pedicled retinal anastomosis group was significantly different from that in the conventional group (P <0.05). The postoperative thoracic drainage, There was no significant difference in chest function, chest tube time, discharge time, thoracoabdominal syndrome, arrhythmia, pulmonary infection and pulmonary function at 1 month after operation. Conclusion The pedicel omentum drape curtain anastomosis, omentum esophageal parietal bandage tube, can effectively reduce the occurrence of anastomotic leakage, is conducive to the rapid recovery of elderly patients.