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目的探究改良套入式包埋吻合在食管癌、贲门癌根治术中的应用和效果。方法回顾性分析2014年1月至2015年5月郑州大学第一附属医院胸外一科同一治疗组食管癌、贲门癌根治手术治疗的160例患者的临床资料。其中男119例、女41例,年龄(61.6±7.1)岁。64例采用Sweet术式,96例采用胸腹腔镜McKeown术式,均行食管-管状胃机械吻合。患者根据包埋方式分为改良组和传统组。改良组46例,男34例、女12例,年龄(61.7±6.4)岁,采用改良套入包埋吻合口;传统组114例,男85例、女29例,年龄(62.2±7.5)岁,采用传统间断水平褥式包埋吻合口。对比观察两种包埋吻合口方式的术后恢复情况。结果与传统组相比,改良组吻合口瘘发生率明显降低(0.0%vs.12.3%,χ~2=4.478,P=0.013),吻合时间明显缩短[(28.9±2.9)min vs.(30.0±3.1)min,t=-1.983,P=0.049],但吻合口狭窄发生率更高(30.4%vs.3.5%,χ~2=23.799,P=0.000)。两组肺部并发症、心血管并发症、喉返神经损伤、围术期死亡率差异无统计学意义(P>0.05)。结论改良套入式包埋吻合在食管癌、贲门癌根治术中安全可行,能够有效降低吻合口瘘发生率。
Objective To investigate the application and effect of improved sleeve-embedded anastomosis in the radical operation of esophageal and cardia cancer. Methods The clinical data of 160 patients who underwent radical resection of esophageal and gastric cardia carcinoma in the same thorax and thoracic surgery department of the First Affiliated Hospital of Zhengzhou University from January 2014 to May 2015 were retrospectively analyzed. There were 119 males and 41 females, with a mean age of (61.6 ± 7.1) years. Sixty-four patients underwent Sweet surgery and 96 patients underwent thoraco-laparoscopic McKeown surgery. All patients underwent esophageal-tubular gastric anastomosis. Patients were divided into modified group and traditional group according to the method of embedding. The modified group of 46 patients, 34 males and 12 females, age (61.7 ± 6.4) years, improved enveloping anastomosis; the traditional group of 114 patients, 85 males and 29 females, age (62.2 ± 7.5) years , Using traditional intermittent horizontal mattress anastomosis. Compare the two kinds of embedding anastomosis way of postoperative recovery. Results Compared with the traditional group, the incidence of anastomotic fistula in the modified group was significantly lower than that in the conventional group (0.0% vs.12.3%, χ ~ 2 = 4.478, P = 0.013), and the anastomotic time was significantly shorter (28.9 ± 2.9min vs30.0 ± 3.1) min, t = -1.983, P = 0.049], but the incidence of anastomotic stenosis was higher (30.4% vs.3.5%, χ ~ 2 = 23.799, P = 0.000). There were no significant differences in pulmonary complications, cardiovascular complications, recurrent laryngeal nerve injury and perioperative mortality between the two groups (P> 0.05). Conclusions The improved enveloping anastomosis is safe and feasible in the radical operation of esophageal cancer and cardia cancer, which can effectively reduce the incidence of anastomotic fistula.