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目的了解食管癌切除术后经不同径路重建,发生吻合口瘘的情况;探讨系统性淋巴结清扫后,经胸骨后胃代食管颈部吻合口瘘发生率较高的原因及预防方法。方法1105例行食管癌切除术的患者,229例经左胸行胸内吻合(A组),716例经右胸食管床胃代食管行颈部吻合(B组),160例予以系统性淋巴结清扫术后经胸骨后行颈部吻合(C组)。分析比较不同手术径路的3组患者术后吻合口瘘发生的情况。结果吻合口瘘发生率分别为:A组5/229(2.2%)、B组85/716(11.9%)、C组31/160(19.4%),C组吻合口瘘发生率显著高于A、B组(P<0.01和P<0.05)。比较C组不同重建方式吻合口瘘发生率显示,手工吻合与器械吻合(22.2%与11.6%,P=0.133)、全胃重建与管状胃重建(25%与15.6%,P=0.146)间吻合口瘘发生率无明显差异,而延长胃肠减压管留置时间至术后7d,吻合口瘘发生率由23.3%降至9.1%(P<0.05)。结论胸骨后胃代食管吻合口瘘发生率较高的主要原因,是前纵隔内的胃体受压、冲击吻合口所致;通过延长胃肠减压管留置时间能有效减少瘘的发生。
Objective To investigate the situation of anastomotic fistula reconstruction after esophageal cancer resection by different pathways and to explore the causes and prevention methods of esophageal and cervical anastomotic fistula after the transposition of the sternum after systemic lymph node dissection. Methods One hundred and ten patients undergoing esophageal resection were enrolled. One hundred and twenty-nine patients underwent thoracic anastomosis (group A), 716 patients underwent esophageal anastomosis through right esophagus (group B) and 160 patients underwent systemic anastomosis The patients underwent sternal anastomosis (C group) after dissection. The incidence of anastomotic fistula in 3 groups of patients with different surgical approaches was analyzed and compared. Results The incidence of anastomotic fistula were 5/229 (2.2%) in group A, 85/716 (11.9%) in group B and 31/160 (19.4%) in group C, and the incidence of anastomotic fistula in group C was significantly higher than that in group A , B group (P <0.01 and P <0.05). Comparing the incidence of anastomotic fistula with different reconstruction methods in group C showed that manual anastomosis was consistent with instrumentation (22.2% vs 11.6%, P = 0.133), and total anastomosis and tubular stomach reconstruction (25% vs 15.6%, P = 0.146) There was no significant difference in the incidence of oral fistula, but prolonged gastrointestinal decompression tube indwelling time to 7 days after operation, the incidence of anastomotic fistula decreased from 23.3% to 9.1% (P <0.05). Conclusions The main reason of esophageal anastomotic fistula in the sternum is the compression and anastomosis of gastric body in the anterior mediastinum. By prolonging the time of gastrointestinal decompression tube indwelling, the occurrence of fistula can be effectively reduced.