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目的比较和评估食管癌切除管状胃食管颈部手工全层吻合、手工分层吻合及器械圆形吻合3种不同吻合方式对术后常见并发症的影响。方法回顾分析2012年10月至2014年3月我科由同一主刀医师完成的3种不同颈部吻合方式食管癌切除62例,其中手工全层吻合组22例,手工分层吻合组19例,器械圆形吻合组21例。比较不同手术方式吻合时间、总手术时间、术后前3d胃液引流、吻合口瘘发生率、瘘口愈合时间、吻合口狭窄发生率、胃食管反流情况等。结果 3组间术后吻合口瘘发生率、吻合口狭窄发生率、胃食管反流情况差异无统计学意义(P>0.05);平均颈部吻合时间器械圆形吻合组[(11.9±1.9)min]<手工分层吻合组[(23.3±3.0)min]<手工全层吻合组[(38.9±4.2)min](P<0.05),但总手术时间3组间差异无统计学意义(P>0.05);瘘口平均愈合时间手工分层吻合组(7d)短于手工全层吻合组(20.8d)及器械圆形吻合组(19d)(P<0.05);术后前3d胃液引流器械圆形吻合组[(325.4±118.4)g]较手工分层吻合组[(515.9±256.5)g]少(P<0.05)。结论 3种吻合方式术后常见并发症和总手术时间无明显差异。器械圆形吻合及手工分层吻合均可有效缩短颈部操作时间,后者瘘口愈合时间更短,前者因胃液引流更少或可减低吻合口出血风险。
Objective To compare and evaluate the effect of three different anastomosis methods on common postoperative complications in patients with resected esophageal cancer: manual full-thickness anastomosis, manual stratified anastomosis and circular anastomosis. Methods From October 2012 to March 2014, 62 cases of esophageal cancer resected by three different neck anastomoses performed by the same chief physician were retrospectively analyzed. Among them, there were 22 cases of manual full-thickness anastomosis and 19 cases of manual stratified anastomosis, Instrument round anastomosis in 21 cases. The time of operation, the time of operation, the drainage of gastric juice before operation, the incidence of anastomotic fistula, the healing time of anastomosis, the incidence of anastomotic stenosis and gastroesophageal reflux were compared. Results The incidence of anastomotic fistula, incidence of anastomotic stenosis and gastroesophageal reflux were not statistically different between the three groups (P> 0.05). The average anastomosis time of round neck anastomosis group (11.9 ± 1.9) (P <0.05). However, there was no significant difference between the three groups in total operation time (P> 0.05) > 0.05). The average healing time of the fistula was shorter in the manual stratified anastomosis group (7d) than in the manual full-thickness anastomosis group (20.8d) and in the circular anastomosis group (19d) (P <0.05) Compared with manual stratified anastomosis group [(515.9 ± 256.5) g], the number of round anastomosis group [(325.4 ± 118.4) g] was less (P <0.05). Conclusion There is no significant difference between the three kinds of anastomosis in common postoperative complications and the total operation time. Instrument circular anastomosis and manual stratified anastomosis can effectively shorten the neck operation time, the latter fistula healing time is shorter, the former due to less gastric juice drainage or reduce the risk of anastomotic bleeding.