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目的比较唇式加固、胃底折叠His角重建与单纯机械吻合对食管贲门癌机械吻合术后的抗返流效果。方法纳入我科2008年3月至2009年10月期间的176例食管贲门癌患者,按入院时间先后分为三个阶段分别实施单纯机械吻合术(机械吻合组,n=42)、机械吻合胃底折叠His角重建术(His角重建组,n=56)及机械吻合唇式加固术(唇式加固组,n=78),术后3个月常规行胃镜检查并活检,以判断其抗返流效果。结果 3组患者间性别、年龄、肿瘤部位、吻合部位及切口部位比较差异均无统计学意义(P>0.05)。术后返流发生率机械吻合组、His角重建组及唇式加固组分别为69.05%、28.57%及14.10%,唇式加固组和His角重建组均明显低于机械吻合组(χ2=37.088,P=0.000;χ2=15.833,P=0.000),且唇式加固组又明显低于His角重建组(2χ=4.241,P=0.039)。唇式加固组无一例出现吻合口漏,术后均安全出院,仅有2例出现中度吻合口狭窄,经扩张后均恢复良好。术后返流发生与吻合部位无关(P>0.05)。结论唇式加固与胃底折叠His角重建在食管贲门癌机械吻合术中均有明显的抗返流作用,唇式加固的抗返流效果更佳,且操作简便。
Objective To compare the anti-reflux effect of lip-reinforcing, fundus folded His angle reconstruction and simple mechanical anastomosis on mechanical anastomosis of esophagus and cardia. Methods A total of 176 patients with esophageal and cardiac cancer who were admitted to our department from March 2008 to October 2009 were randomly divided into three phases according to the time of admission. The patients were treated with simple mechanical anastomosis (mechanical anastomosis, n = 42), mechanical anastomosis His angle reconstruction (His angle reconstruction group, n = 56) and mechanical anastomosis lip augmentation (lip augmentation group, n = 78) were performed. Gastroscopy and biopsy were performed routinely at 3 months Backflow effect. Results There was no significant difference in gender, age, tumor location, anastomosis site and incision site between the three groups (P> 0.05). The rate of postoperative reflux in mechanical anastomosis group, His angle reconstructive group and lip-type consolidation group were 69.05%, 28.57% and 14.10%, respectively. The lip-fixed group and His angle reconstruction group were significantly lower than those in mechanical anastomosis group (χ2 = 37.088 , P = 0.000; χ2 = 15.833, P = 0.000), and the lip-augmented group was significantly lower than the His angle reconstruction group (2χ = 4.241, P = 0.039). None of the lip augmentation group had anastomotic leaks and were safely discharged after surgery. Only 2 patients had moderate anastomotic stenosis and recovered well after dilation. Postoperative reflux had no relation with anastomotic site (P> 0.05). Conclusion Both lip-reinforcing and fundus folded His angle reconstruction have significant anti-reflux effect in mechanical anastomosis of esophageal and cardial cardia, lip-reinforcing anti-reflux effect is better, and the operation is simple.