中国胸心血管外科临床杂志

中国胸心血管外科临床杂志

食管胃吻合角度与吻合口良性狭窄相关性的随机对照试验

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目的 探讨食管胃端侧吻合角度与吻合口良性狭窄形成的相关性。 方法 纳入 2011 年 1 月至 2015 年 6 月上海市浦东医院和浙江省丽水市中心医院通过左胸单一切口完成中下段食管癌及贲门癌手术的患者,随机选择两种角度的吻合技术,排除术后 6 个月内失访病例,共入组 130 例,分为食管胃 0 度吻合组(对照组)65 例[其中男 49 例、女 16 例,年龄(64.5±8.3)岁]和食管胃 45 度吻合组(试验组)65 例[其中男 52 例、女 13 例,年龄(61.7±9.1)岁],比较两组患者术后 6 个月的进食情况,以评价两种吻合技术与吻合口良性狭窄的相关性。 结果 两组均无手术死亡。术后病理示 116 例食管鳞癌,14 例腺癌。上、下切缘无癌残留。对照组和试验组各发生吻合口瘘 2 例,两组术后吻合口瘘发生率相似,试验组术后 6 个月吻合口狭窄发生率较低,差异有统计学意义;试验组与对照组相比术后拔除胸腔引流管时间 [(5.9±6.7)d vs.(5.8±6.8)d]及肠蠕动恢复时间 [(2.6±0.8)d vs.(2.6±0.7)d]差异无统计学意义。 结论 食管胃的吻合角度与术后吻合口良性狭窄相关,45 度斜行吻合有利于减轻术后吻合口狭窄程度。

Objective To investigate the correlation between end-to-side anastomotic angle and postoperative anastomotic stricture in the surgery of esophageal carcinoma. Methods From January 2011 to June 2015, 130 patients with middle/lower esophageal carcinoma or gastric cardia cancer underwent operations in Shanghai Pudong Hospital and Lishui Central Hospital, Zhejiang Province. Depending on the end-to-side anastomotic angle, they were randomly divided into two groups (n=65 in each): a 0 degree group (49 males and 16 females, aged 64.5±8.3 years) and a 45 degrees group (52 males, 13 females, aged 61.7±9.1 years). Stooler degree grading was adopted to evaluate the anastomotic stricture in each group 6 months postoperatively. Results There were two patients with anastomotic fistula in each group (P>0.05). Pathology showed squamous carcinoma in 116 patients and adenocarcinoma in 14 patients. The postoperative esophageal stricture in the 45 degrees group was significantly less than that in the 0 degree group. There was no statistical difference in the duration of chest tube (5.9±6.7 dvs. 5.8±6.8 d) and recovery of intestinal peristalsis (2.6±0.8 d vs.2.6±0.7 d) between the 45 degrees group and the 0 degree group. Conclusion Esophagogastric anastomotic angle is related to the formation of postoperative anastomotic stricture. Oblique anastomosis with 45 degrees is helpful to decrease the severity of stricture.

关键词: 食管癌; 吻合角度; 吻合口狭窄

Key words: Esophageal carcinoma; anastomotic angle; anastomotic stricture

引用本文: 熊健, 郑春辉, 许咏冬. 食管胃吻合角度与吻合口良性狭窄相关性的随机对照试验. 中国胸心血管外科临床杂志, 2017, 24(12): 947-951. doi: 10.7507/1007-4848.201612061 复制

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