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食管癌是常见的恶性肿瘤之一,其发病率及死亡率均位于恶性肿瘤的前列[1-2]。目前食管癌的治疗方式仍以手术和放化疗为主。近年来食管癌的手术方式发展迅速,逐渐由开放手术向腔镜手术转变。胃仍然是食管癌手术中最常用的替代食管的重建器官。由于全胃代食管术后胸胃综合征、反流性食管炎、肺不张、肺部感染等并发症发生率较高,对于围术期恢复及术后生活质量造成较大影响,目前已很少应用[3]。近年来切割型管状胃已广泛应用于食管癌手术中,取得很好的临床疗效,减轻了术后胸胃综合征的发生率,改善肺功能,减轻了反流性食管炎,提高改善术后生活质量[4],缺点为影响残胃静脉回流,手术操作相对耗时、复杂、术后残胃易出血,另外高值耗材用量多,加重了病人经济负担。我们改良了管状胃的制作方法,采用非切割型管状胃替代食管,观察在开放手术中治疗食管癌的短期临床效果,探讨该术式的可行性、安全性。
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全部病人均顺利完成手术,无术中意外大出血情况等。观察组手术时间、管状胃长度与耗材用量均少于对照组的手术时间(209.17±47.19)min、管状胃长度(39.98±2.10)cm和耗材用量(3.39±0.78)个(P < 0.05~P < 0.01);2组术中出血量、术后2 d胸腔引流总量及住院时间差异均无统计学意义(P > 0.05)(见表 1)。
分组 n 手术时间/min 术中
出血量/mL管状
胃长度/cm切割缝合器
数量/个术后2 d
胸引量/mL住院时间/d 观察组 24 183.75±25.80 225.00±88.47 32.66±3.63 1.25±1.11 460.42±225.42 18.54±7.74 对照组 23 209.17±47.19 224.35±123.02 39.98±2.10 3.39±0.78 431.74±201.92 17.65±4.74 t — 2.31 0.02 8.42 7.60 0.46 0.47 P — < 0.05 > 0.05 < 0.01 < 0.01 > 0.05 > 0.05 表 1 2组病人手术观察指标比较(x ±s)
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2组病人均未发生吻合口瘘及残胃瘘;肺部感染及胸腔积液的发生率相对于其他并发症略高,均经抗感染、引流后治愈;切口感染1例经换药后治愈。2组围术期并发症发生率差异无统计学意义(P > 0.05)(见表 2)。
分组 n 肺部
感染吻合
口瘘残胃瘘 胸腔
积液切口
感染合计
并发症χ2 P 观察组 24 4(16.67) 0(0.00) 0(0.00) 3(12.50) 1(4.17) 8(33.33) 0.17 > 0.05 对照组 23 3(13.04) 0(0.00) 0(0.00) 6(26.08) 0(0.00) 9(39.12) 合计 47 7(14.89) 0(0.00) 0(0.00) 9(19.15) 1(2.13) 17(36.17) 表 2 2组病人围术期并发症比较[n;百分率(%)]
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2组病人短期随访并发症发生率差异无统计学意义(P > 0.05)(见表 3)。
分组 n 迟发性
吻合口瘘吻合口
狭窄胸胃
扩张反流性
食管炎合计 χ2 P 观察组 24 0(0.00) 2(8.33) 1(4.16) 3(12.49) 7(29.17) 0.51 > 0.05 对照组 23 0(0.00) 4(17.39) 0(0.00) 5(21.74) 9(39.13) 合计 47 0(0.00) 6(12.77) 1(4.35) 8(17.02) 16(34.04) 表 3 2组病人短期随访并发症比较[n;百分率(%)]
改良非切割型管状胃在食管癌根治术中的应用
Application of modified uncut tubular stomach in radical resection of esophageal carcinoma
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摘要:
目的探讨改良非切割型管状胃与传统切割型管状胃在食管癌根治术中临床应用的可行性、安全性及短期临床效果。 方法回顾性分析47例食管癌根治术病人的临床资料。所有病人术前均胃镜证实为食管癌。分为改良非切割型管状胃组24例,传统切割型管状胃组23例;分析2组病人手术时间、术中出血、管状胃长度、耗材用量及术后观察指标、出院短期随访等。 结果全部病人均顺利完成手术,无术中大出血等意外情况发生;改良非切割型管状胃组手术时间、管状胃长度与耗材用量均少于传统切割型管状胃组(P < 0.05~P < 0.01);2组术中出血、术后2 d胸腔引流总量及住院时间差异均无统计学意义(P>0.05);改良非切割型管状胃组围术期和短期随访并发症发生率与传统切割型管状胃组差异均无统计学意义(P>0.05),无严重并发症及死亡病例。 结论改良非切割型管状胃可缩短手术时间、降低耗材量,且不会增加吻合口瘘及狭窄、肺部感染、术后返酸、胸胃扩张等术后并发症。 Abstract:ObjectiveTo investigate the feasibility, safety and short-term clinical effects of the application of modified uncut tubular stomach and traditional cut tubular stomach in radical surgery of esophageal carcinoma. MethodsThe clinical data of 47 patients treated with radical surgery of esophageal carcinoma were retrospectively analyzed.All patients with esophageal cancer were confirmed by gastroscopy before surgery.The patients were divided into the modified uncut tubular stomach group(24 cases) and traditional cut tubular stomach group(23 cases).The operation time, intraoperative bleeding, length of tubular stomach, material usage, postoperative observation index and short-term follow-up after discharge in two groups were analyzed. ResultsAll operations were successfully completed, no intraoperative bleeding and other accidents occurred.The operation time, length of tubular stomach and material usage in modified uncut tubular stomach group were less than those in traditional cut tubular stomach group(P < 0.05 to P < 0.01).The differences of the intraoperative hemorrhage, postoperative 2 d thoracic drainage amount, length of hospital stay, incidence rates of complications during perioperative period and short-term follow-up between two groups were not statistically significant(P>0.05).There was no serious complication or death. ConclusionsThe modified uncut tubular stomach can shorten the operation time and reduce the material usage, and does not increase the anastomotic fistula and stenosis, pulmonary infection, postoperative acid reflux, and chest and stomach dilation. -
Key words:
- esophageal neoplasms /
- digestive tract reconstruction /
- tubular stomach
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表 1 2组病人手术观察指标比较(x ±s)
分组 n 手术时间/min 术中
出血量/mL管状
胃长度/cm切割缝合器
数量/个术后2 d
胸引量/mL住院时间/d 观察组 24 183.75±25.80 225.00±88.47 32.66±3.63 1.25±1.11 460.42±225.42 18.54±7.74 对照组 23 209.17±47.19 224.35±123.02 39.98±2.10 3.39±0.78 431.74±201.92 17.65±4.74 t — 2.31 0.02 8.42 7.60 0.46 0.47 P — < 0.05 > 0.05 < 0.01 < 0.01 > 0.05 > 0.05 表 2 2组病人围术期并发症比较[n;百分率(%)]
分组 n 肺部
感染吻合
口瘘残胃瘘 胸腔
积液切口
感染合计
并发症χ2 P 观察组 24 4(16.67) 0(0.00) 0(0.00) 3(12.50) 1(4.17) 8(33.33) 0.17 > 0.05 对照组 23 3(13.04) 0(0.00) 0(0.00) 6(26.08) 0(0.00) 9(39.12) 合计 47 7(14.89) 0(0.00) 0(0.00) 9(19.15) 1(2.13) 17(36.17) 表 3 2组病人短期随访并发症比较[n;百分率(%)]
分组 n 迟发性
吻合口瘘吻合口
狭窄胸胃
扩张反流性
食管炎合计 χ2 P 观察组 24 0(0.00) 2(8.33) 1(4.16) 3(12.49) 7(29.17) 0.51 > 0.05 对照组 23 0(0.00) 4(17.39) 0(0.00) 5(21.74) 9(39.13) 合计 47 0(0.00) 6(12.77) 1(4.35) 8(17.02) 16(34.04) -
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