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目的探讨管状胃在食管癌切除术食管胃颈部吻合中的临床应用,总结其经验。方法将苏北人民医院2007年1月至2009年1月经“颈、胸、腹”三切口手术治疗食管癌患者850例,按手术先后分成A、B两组。A组行管状胃代食管手术,共425例,男287例,女138例;年龄(58.2±11.5)岁,其中食管上段癌27例,食管中段癌346例,食管下段癌52例。B组行全胃代食管手术,共425例,男298例,女127例;年龄(58.5±12.8)岁,其中食管上段癌33例,食管中段癌338例,食管下段癌54例。观察两组患者手术时间、住院时间以及术后吻合口瘘、吻合口狭窄、胸胃综合征、反流性食管炎等术后并发症的发生情况。结果全组患者均顺利完成手术,无死亡患者,A、B两组手术时间[(175.0±12.8)min vs.(171.0±10.5)min,t=1.702,P>0.05]和术后住院时间[(16.0±8.5)dvs.(16.3±8.8)d,t=1.773,P>0.05]差异均无统计学意义。术后随访6个月,无失访,A组吻合口瘘(χ2=5.550,P<0.05),反流性食管炎(χ2=9.150,P<0.05),胸胃综合征(χ2=10.500,P<0.05)等并发症发生率比B组低,且差异有统计学意义。两组吻合口狭窄发生率差异无统计学意义(χ2=0.120,P>0.05)。结论在经“颈、胸、腹”三切口治疗食管癌手术中,管状胃代食管更符合生理解剖要求,降低吻合口瘘、胸胃综合征及反流性食管炎等并发症发生率,改善患者术后生活质量。
Objective To investigate the clinical application of tubular stomach in esophageal and gastric anastomosis for esophageal resection and summarize its experience. Methods From January 2007 to January 2009, 850 patients with esophageal cancer were treated by three incisions of “neck, chest and abdomen” in the People’s Hospital of Jiangsu Province from January 2007 to January 2009, and divided into A and B groups according to the operation. In group A, there were 425 cases of tubular esophagectomy, including 287 males and 138 females, aged 58.2 ± 11.5 years, including 27 cases of upper esophageal cancer, 346 cases of middle esophageal cancer and 52 cases of lower esophageal cancer. There were 425 men, 298 men and 127 women, aged 58.5 ± 12.8 years old. Among them, 33 were upper esophageal cancer, 338 were middle esophageal cancer, and 54 were esophageal lower esophageal cancer. The incidence of postoperative complications such as anastomotic fistula, anastomotic stenosis, thoraco-gastric syndrome and reflux esophagitis were observed in two groups. Results All the patients were successfully operated without any death. The operative time in group A and B was (175.0 ± 12.8) min vs. (171.0 ± 10.5) min, t = 1.702, P> 0.05, and the postoperative length of stay [ (16.0 ± 8.5) dvs. (16.3 ± 8.8) d, t = 1.773, P> 0.05]. The patients were followed up for 6 months without any loss of follow-up. The anastomotic fistula (χ2 = 5.550, P <0.05), reflux esophagitis (χ2 = 9.150, P <0.05) and other complications than in group B, and the difference was statistically significant. There was no significant difference in the incidence of anastomotic stenosis between the two groups (χ2 = 0.120, P> 0.05). Conclusion In the treatment of esophageal cancer by the three incisions of “neck, chest and abdomen”, the tubular gastric esophagus is more suitable for physiological anatomy and reduces the incidence of complications such as anastomotic fistula, thoraco-gastric syndrome and reflux esophagitis , Improve patient quality of life after surgery.