低位和高位颈椎前路减压融合术后椎前软组织肿胀及吞咽困难发生率的比较分析

[目的]比较分析低位和高位颈椎前路融合术后椎前软组织肿胀程度和吞咽困难发生率。[方法]研究共纳入行颈椎前路融合术的颈椎病患者123例,其中低位组(C5以下)51例,高位组72例(C5以上,包括C4、5),根据侧位X线测量计算椎前软组织肿胀宽度,比较分析术后椎前软组织肿胀程度及吞咽困难发生率。同时,根据手术节段长短将样本分为单节段融合组(n=50)和双节段融合组(n=48),再进行组内低位和高位组间的比较分析,以消除手术节段长短对分析结果的影响。[结果]低位组术后椎前软组织肿胀宽度为(8.63±4.44)mm,吞咽困难发生率为41.2%,均低于高位组的(12.10±4.77)mm和63.9%(P<0.05)。对于单节段融合手术,低位组术后椎前软组织肿胀宽度为(8.37±4.22)mm,吞咽困难发生率为36.1%,均低于高位组的(9.63±3.44)mm和50.0%(P<0.05)。对于双节段融合手术,低位组术后椎前软组织肿胀宽度为(9.27±4.96)mm,吞咽困难发生率为53.3%,均低于高位组的(13.24±4.75)mm和75.8%(P<0.05)。[结论]高位颈椎手术可能是颈椎前路术后椎前软组织肿胀和吞咽困难发生的危险因素之一,术前针对相关患者进行宣教具有一定的必要性和临床意义。     

单节段和双/多节段颈椎前路减压融合术后椎前软组织肿胀及吞咽困难发生率的比较

目的比较分析单节段和双/多节段颈椎前路融合术后椎前软组织肿胀程度和吞咽困难发生率。方法纳入颈椎前路融合术病例123例,单节段组50例,双/多节段组73例,在侧位X线片上测量椎前软组织宽度,比较术后椎前软组织肿胀程度及吞咽困难发生率。结果单节段组术后椎前软组织肿胀宽度为(8.29±3.98)mm,吞咽困难发生率为40.0%,均低于双/多节段组的(11.14±5.17)mm和64.4%。且无论高位(C4/C5节段及以上)或低位手术(C5节段以下),单节段术后椎前软组织肿胀宽度和吞咽困难发生率均低于双/多节段术后。结论多节段手术可能是颈椎前路手术术后椎前软组织肿胀和吞咽困难发生的危险因素之一,术前针对相关人群的宣教具有一定的必要性和临床意义。     

颈前路多节段融合术后吞咽困难的原因分析

目的 比较多节段颈前路椎间盘切除减压融合术中采用传统钢板+cage和“零切迹”颈椎椎间融合器植入患者术后吞咽困难的发生情况,并分析其原因.方法 2008年9月至2011年9月,接受颈前路椎间盘切除减压+前路钢板+cage植入的118例多节段颈椎病患者为钢板cage组,接受颈前路椎间盘切除减压+Zero-p颈椎椎间融合器植入的108例患者为Zero-p组.分别于术前、术后第2天、术后3、6、12个月及末次随访时采用日本矫形外科学会评分法(Japan orthopedic association,JOA)对患者的神经功能情况进行评估;摄颈椎X片评价植骨融合程度、内固定相关并发症及椎前软组织肿胀程度;采用Bazaz吞咽困难分级及改良吞咽生活质量量表(swallowing-quality of life,SWAL-QOL)评估患者吞咽困难的发生率及相关症状发生情况.结果 随访时间平均为2.4年(1.0～3.5年).术后第2天钢板cage组发生吞咽困难49例(41.53％)明显高于Zero-p组(36例,33.33％);钢板cage组术后第2天及术后2个月椎前软组织厚度明显大于Zero-p组.术后第2天Zero-p组中手术范围为C3～C6的患者吞咽困难发生率(43.1％)明显高于手术范围为C4～C7的患者(22％).结论 颈前路多节段融合术后吞咽困难不可避免,内固定的选择和手术范围是术后吞咽困难发生的重要影响因素.使用颈椎“零切迹”植入物可以减少术后吞咽困难的发生率,手术节段越高术后吞咽困难的发生率越高.     

颈前路减压Zero-P融合固定术后吞咽困难的影响因素

目的 :分析颈前路减压Zero-P融合固定术后吞咽困难的影响因素。方法 :对2011年1月～2016年12月行颈前路减压Zero-P融合固定术且至少1年以上的115例患者的资料进行回顾性分析。其中男66例,女49例。采用电话或门诊随访的方式,以Bazaz评分系统评估术后3d吞咽困难程度,根据是否存在术后吞咽困难将所有患者分为吞咽困难组(轻、中、重度吞咽困难患者)和无吞咽困难组,分析性别、年龄、身体质量指数(body mass index,BMI)、糖尿病、高血压、吸烟、饮酒、手术时间、术中出血量、术后椎前软组织肿胀程度(术后软组织厚度与术前软组织厚度的差值)、术后O-C2角度、术后C2-7角度、手术最高节段、手术节段数等因素与术后吞咽困难发生的相关性,并重点探讨术后C2-7角度这一因素。两组间定量变量的差异采用独立样本t检验的方法进行比较,定性变量差异进行卡方检验。为排除混杂因素影响,将单因素分析中P0.2的因素纳入二元Logistic回归模型进行多因素汇总分析。采用Spearman秩相关检验验证术后C2-7角度与吞咽困难严重程度的相关性。结果:吞咽困难组18例,男11例,女7例;无吞咽困难组97例,男55例,女42例。单因素分析结果显示,年龄、术后O-C2角度、术后C2-7角度及椎前软组织肿胀程度两组间比较均有统计学差异(P0.05),性别、BMI、糖尿病、高血压、吸烟、饮酒、手术时间、术中出血量、手术最高节段、手术节段数两组间比较均无统计学差异(P0.05)。单因素分析中P0.2的因素包括年龄、BMI、术中出血量、术后O-C2角度、术后C2-7角度及术后椎前软组织肿胀。将单因素分析中P0.2的因素纳入Logistic回归分析,术后C2-7角度及椎前软组织肿胀与术后发生吞咽困难呈显著相关(P0.05),年龄、BMI、术中出血量和术后O-C2角度与术后吞咽困难的发生均无显著相关性(P0.05)。吞咽困难组术后C2-7角度为9.17°～36.39°(19.14°±6.73°),无吞咽困难组为1.59°～20.45°(10.88°±5.36°),吞咽困难组术后C2-7角显著大于无吞咽困难组(P0.05)。将C2-7角≥12°时的吞咽困难发生率(26.2%,16/61)和C2-7角12°时吞咽困难的发生率(3.7%,2/54)进行比较,差异有统计学意义(P0.05)。将18例吞咽困难患者(轻度16例,重度2例)的术后C2-7角度与吞咽困难等级进行Spearman秩相关分析,结果显示两者不存在显著相关性(P0.05)。结论:颈前路减压Zero-P融合固定术后C2-7角度及椎前软组织肿胀对患者术后吞咽困难的发生有重要的影响,术中注意C2-7角度的调整及控制术后的椎前软组织肿胀可降低患者术后发生吞咽困难的风险。     

应用Zero-P行颈前路椎间融合术治疗外伤性颈椎椎间盘突出并脊髓损伤

目的比较应用Zero-P和钛板并Cage行颈前路椎间融合术治疗外伤性颈椎椎间盘突出并脊髓损伤的临床疗效。方法回顾性分析本院2012年2月—2015年11月收治的78例外伤性颈椎椎间盘突出并脊髓损伤患者临床资料。其中38例行前路椎间盘切除、钛板并Cage内固定融合(Cage组),40例应用Zero-P行颈前路椎间融合术(Zero-P组)。比较2组患者术前及术后随访期间Frankel分级、颈椎曲度、椎间融合率、吞咽困难发生率等情况。结果所有患者随访12~37(15.76±3.80)个月。2组患者术后Frankel分级均较术前明显改善,差异有统计学意义(P0.05),2组间比较差异无统计学意义(P0.05)。2组术后颈椎曲度均较术前明显改善,与术前相比差异有统计学意义(P0.05),2组间比较差异无统计学意义(P0.05),且至末次随访时颈椎曲度无丢失。术后3个月,Zero-P组融合率高于Cage组,吞咽困难发生率显著低于Cage组,差异有统计学意义(P0.05)。末次随访时2组融合率差异无统计学意义(P0.05)。结论传统钛板并Cage内固定融合术与应用Zero-P行椎间融合术治疗外伤性颈椎椎间盘突出并脊髓损伤均可显著改善患者脊髓功能,但Zero-P具有术后早期即可获得较高融合率及术后吞咽困难发生率低的优点。     

缝合椎前筋膜预防颈前路术后吞咽困难的临床研究

目的：探讨缝合椎前筋膜对颈椎前路内固定术后吞咽困难的预防作用。方法：将176例行颈前路手术、钛板内固定患者于手术前一天掷钱币方式随机分为2组。A组89例（缝合椎前筋膜组）：术中颈前路钢板固定后缝合椎前筋膜,覆盖钢板,使食管不直接与钢板相贴。B组87例（不缝合椎前筋膜组）：术中固定后不缝合椎前筋膜,食管与钢板直接相贴。分别于术后3周及3、12个月对患者进行随访,以吞咽困难患者数及吞咽困难发生率作为观测指标。结果：A组术后3周及3、12个月吞咽困难发生率分别为25.8%、9.0%、5.6%;B组为25.3%、20.6%、14.9%。经统计学处理,3、12个月时吞咽困难发生率A组低于B组,差异有统计学意义（3个月时P=0.030,12个月时P=0.049,均〈0.05）。结论：缝合椎前筋膜能有效地预防颈椎前路内固定术后吞咽困难的发生。     

颈前路椎间盘切除椎间融合器融合术加颈后路单开门术治疗脊髓型颈椎病

[目的]探讨颈椎前路椎间盘切除椎间融合器融合术加颈椎后路单开门椎管扩大成形术治疗脊髓型颈椎病在临床上的应用价值。[方法]应用Cervical Cage行颈椎前路椎间盘切除椎间融合术，同时，颈椎后路行单开门椎管扩大成形术11例，平均随访6个月。按40分法和JOA评分对手术前后脊髓功能进行评分，并测量颈椎术前术后前柱高度及椎管宽度和进行相关性分析．[结果]颈椎前路椎间盘切除椎间融合器融合术加颈椎后路单开门椎管扩大成形术，明显改善脊髓型颈椎病的脊髓功能。40分法平均37分，改善率83％；JOA评分16．5分，改善率91％；前柱高度平均增加1．28mm；椎管宽度平均增加2．22mm。[结论]颈椎前路椎间盘切除椎间融合器融合术加颈椎后路单开门椎管扩大成形术，有效恢复了颈椎前柱高度、增加椎管宽度，明显改善了脊髓型颈椎病的脊髓功能。     

多节段颈椎病不同手术方法的比较

目的 探讨多节段颈椎病手术治疗方案的选择及前路手术的临床应用价值。方法 对132例多节段颈椎病患者，采用前路手术方法治疗113例，后路手术方法治疗11例，前后路联合手术方法治疗8例。观察患者神经功能改善、颈椎椎间高度和颈椎生理曲度恢复和重建。结果 所有患者术后JOA评分均有改善，前路手术方法治疗组JOA改善率为58．5％，后路手术方法治疗组54．6％；前后路联合方法治疗组56．8％；各手术组患者颈椎Cobb角、D值术后与术前比较均有显著性差异（P〈0．01）；椎间高度前路手术方法术后与术前比较有显著性差异（P〈0．01），后路手术方法术后与术前比较差异无统计学意义（P〉0．05）；前路与后路Cobb角、D值、椎间高度差值比较有显著性差异（P〈0．01）。结论 多节段颈椎病患者的手术治疗能显著改善其神经功能，颈前路手术方法椎间高度及生理曲度恢复和重建优于颈后路手术方法。     

颈前路椎间融合术限制型与半限制型钢板内固定治疗颈椎病的比较研究

目的比较颈前路椎间融合术中限制型与半限制型钢板内固定治疗颈椎病术后维持颈椎前凸和椎间高度的差异。方法回顾性分析自2002-01—2014-12诊治的62例脊髓型颈椎病,其中28例行颈前路减压+钛网植骨融合+限制型钢板内固定术(限制型钢板组),34例行颈前路减压+钛网植骨融合+半限制型钢板内固定术(半限制型钢板组),比较2组术后植骨融合率、颈椎曲度、椎间高度及JOA评分。结果 62例均获得随访8~12个月,平均11个月。2组植骨材料(钛网)均与相邻椎体骨性融合。半限制型钢板组术后1年Cobb角较术后3 d增加幅度更大,差异有统计学意义(t=-9.894,P0.001)。2组术后1年与术后3 d的D值与融合节段椎体高度变化差异无统计学意义(P0.05)。2组术后3 d(t=0.801,P=0.426)与术后1年(t=0.437,P=0.663)的JOA评分比较差异无统计学意义(P0.05)。结论限制型与半限制型钢板均可提供颈前路椎间融合术后颈椎的稳定性直至植骨材料(钛网)与相邻椎体骨性融合。钛网植骨和半限制型钢板共同使用时,更容易发生融合节段曲度的丢失。     

颈前路椎体次全切术后椎前软组织肿胀的影像学研究

目的:研究颈前路椎体次全切钛网植骨融合内固定术后椎前软组织肿胀的变化规律。方法:自2015年11月至2018年7月进行颈前路单一椎体次全切钛网植骨融合内固定术治疗脊髓型颈椎病患者151例,男109例,女42例;年龄44~81(59.77±8.34)岁。通过术后随访观察,测量C_2-C_7平面椎前间隙距离,评估椎前软组织肿胀变化规律。结果:151例患者术后均获得随访,时间15~40(28.00±3.52)个月。颈前路单一椎体次全切钛网植骨融合内固定手术后1周,椎前软组织肿胀达到高峰,随后出现椎前软组织肿胀减退,术后8个月时C_5、C_6、C_7平面椎前软组织肿胀恢复正常,术后12个月时C2、C3、C4平面椎前软组织恢复正常。结论:前路颈椎体次全切钛网植骨融合内固定手术后椎前软组织均会发生肿胀,术后1周内应高度重视患者椎前软组织肿胀的加重,避免吞咽困难、呼吸道梗阻、窒息等并发症的发生。     

Dysphagia and soft-tissue swelling after anterior cervical surgery: a radiographic analysis

Background contextDysphagia is common in the early postoperative period after anterior cervical discectomy and fusion (ACDF). Several mechanisms, including soft-tissue swelling, have been implicated as a cause of postoperative dysphagia.PurposeTo determine whether anterior soft-tissue swelling is greater in patients with postoperative dysphagia.Study designProspective cohort study.Patient sampleForty-three patients.Outcome measuresValidated dysphagia questionnaire, lateral cervical spine radiographs.MethodsPatients undergoing one- or two-level ACDF using allograft bone and anterior instrumentation were enrolled. Baseline patient demographic characteristics and history were recorded. A dysphagia questionnaire, including a dysphagia numeric rating scale (DNRS; range, 0–10), was administered preoperatively and 2 and 6 weeks postoperatively. Lateral cervical radiographs were obtained preoperatively and 2 and 6 weeks postoperatively. The anterior cervical soft-tissue shadow width was measured at each level. Patients were divided into groups based on the 2-week dysphagia questionnaire: Group 1 (no symptoms/mild dysphagia) and Group 2 (moderate/severe dysphagia). Anterior soft-tissue shadow width at each level was compared between groups. Correlation was used to assess the relationship between DNRS and anterior soft-tissue swelling.ResultsForty-three patients (24 females; average age, 47.9) were enrolled. Fifteen patients had one-level and 28 patients had two-level ACDF. The anterior soft-tissue shadow width increased significantly from preoperative values at all levels except C1 at 2 and 6 weeks and C2 at 6 weeks. At 2 weeks, 18 patients had no symptoms/mild dysphagia (Group 1) and 25 patients had moderate/severe dysphagia (Group 2). The average DNRS was 1.1 for Group 1 and 5.3 for Group 2 (p<.001). This difference decreased by 6 weeks but remained significant. There were no significant differences in the soft-tissue measurements between groups at any level. There was no significant correlation between the DNRS and anterior soft-tissue swelling at any time point.ConclusionsThere is a significant increase in anterior cervical soft-tissue swelling after ACDF. The width of prevertebral soft-tissue does not correlate with postoperative dysphagia.     

The role of steroid administration in the management of dysphagia in anterior cervical procedures

Dysphagia is a common postoperative symptom for patients undergoing anterior cervical spine procedures. The purpose of this study is to present the current literature regarding the effect of steroid administration in dysphagia after anterior cervical spine procedures. We performed a literature search in the PubMed database, using the following terms: “dysphagia,” “ACDF,” “cervical,” “surgery,” “anterior,” “spine,” “steroids,” “treatment,” and “complications.” We included in our review any study correlating postoperative dysphagia and steroid administration in anterior cervical spine surgery. Studies, which did not evaluate, pre- and postoperatively, dysphagia with a specific clinical or laboratory methodology were excluded from our literature review. Five studies were included in our results. All were randomized, prospective studies, with one being double blinded. Steroid administration protocol was different in every study. In two studies, dexamethasone was used. Methylprednisolone was administrated in three studies. In four studies, steroids were applied intravenously, while in one study, locally in the retropharyngeal space. Short-term dysphagia and prevertebral soft tissue edema were diminished by steroid administration, according to the results of two studies. In one study, prevertebral soft tissue edema was not affected by the steroid usage. Furthermore, short-term osseous fusion rate was impaired by the steroid administration, according to the findings of one study. The usage of steroids in patients undergoing anterior cervical spine procedures remains controversial. Multicenter, large-scale, randomized, prospective studies applying the same protocol of steroid administration and universal outcome criteria should be performed for extracting statistically powerful and clinically meaningful results.     

Surgical treatment of dysphagia after anterior cervical interbody fusion.

BACKGROUND CONTEXT: Dysphagia is a frequent complication after anterior cervical interbody fusion (ACIF). Although dysphagia usually improves over 6 months, it remains a significant and persistent problem for some patients. The etiology is poorly understood but has been reported to be associated with vocal cord paralysis, dislodgement of instrumentation and unidentified causes, such as hematoma, adhesion formation and denervation of the pharyngeal plexus. A surgical treatment of dysphagia after ACIF has not been reported. PURPOSE: We report the surgical treatment of persistent dysphagia occurring after ACIF with instrumentation. STUDY DESIGN/SETTING: A retrospective review of cervical discectomy and interbody fusion patients identified a subset of patients with symptomatic dysphagia who chose surgical treatment of the dysphagia. The hypothesis is that removal of the anterior cervical plate will release mechanical adhesions of the esophagus to the anterior spine around the plate. Outcome was graded by examination and a final telephonic interview with a dysphagia questionnaire. METHODS: Thirty-one patients who elected surgical treatment for persistent dysphagia were assessed at clinic visits after surgery at 3, 6 and 12 months for symptomatic dysphagia, and with a final telephonic questionnaire. The average time from initial surgery to time of surgical treatment for dysphagia was 18 months. Final follow-up was an average 11 months (range, 6 to 25 months) with a dysphagia questionnaire using the Bazaz-Yoo dysphagia score. Thirty-one patients responded to a phone questionnaire with the Bazaz-Yoo dysphagia score. RESULTS: The primary operative finding was extensive adhesions attaching the esophagus to the prevertebral fascia and anterior cervical spine around the periphery of the cervical plate. Seventeen patients (55%) were significantly improved to no dysphagia of solids and liquids (p < or = .0001). Ten patients (32%) reported mild dysphagia occasionally with specific foods. Three patients had persistent moderate occasional dysphagia with solid food. Two patients had persistent severe dysphagia of solids and liquids. Previous cervical surgery, particularly with pre-existing dysphagia, and unexpectedly extreme amounts of adhesions at surgery were contributing factors to the cases with persistent severe dysphagia. CONCLUSIONS: Surgical treatment of dysphagia after ACIF has not been reported. Removal of the cervical instrumentation in patients will improve the dysphagia. This improvement with surgical management, as compared with the dissatisfaction before surgical treatment, documents that this surgical treatment is a reasonable option.     

The clinical efficacy of short-term steroid treatment in multilevel anterior cervical arthrodesis

Background contextDysphagia is the most common complication of anterior cervical discectomy and fusion (ACDF), and it is closely related to prevertebral soft-tissue swelling (PSTS). A few studies have found that local or systemic methylprednisolone is effective against laryngopharyngeal edema and airway obstruction.PurposeTo assess the effectiveness of short-term use of systemic methylprednisolone in relieving dysphagia and decreasing PSTS during the hospitalization period.Study designA prospective study.Patient sampleForty patients who underwent multilevel (more than three levels) ACDF with same plate fixation.Outcome measureRadiologic and clinical measures.MethodsTwenty of these patients were given 250 mg of methylprednisolone intravenously (IV) four times a day only for 24 hours after the operation (at 6-hour intervals), whereas the remaining 20 did not receive methylprednisolone and served as controls. We used the Bazaz scale to compare the degree of dysphagia between groups during the hospitalization period. We used the C-spine lateral view to assess the degree of pre- and postoperative PSTS from C2 to C7. At the final follow-up, we assessed the relationship between the occurrence of complications and steroid use.ResultsThe degree of dysphagia according to the Bazaz scale was less severe in the group that received methylprednisolone (p values; postoperative Day [POD] 2～5<.05, POD 6=.014, POD 7=.019). Prevertebral soft-tissue swelling was also significantly lower in the group that received methylprednisolone (p values; POD 2～POD 5 <.005, POD 1=.061, POD 6=.007, POD 7=.091). The amount of PSTS and dysphagia did not differ according to sex, age, smoking history, or length of surgery. The period of hospitalization in the experimental group was shorter than in the control group. No complications related to steroid use were found at the final follow-up.ConclusionsThe short-term use of systemic methylprednisolone after ACDF appears to be effective in relieving dysphagia and decreasing the PSTS. Furthermore, the short-term use of methylprednisolone was not associated with any adverse effects of short-term IV steroid usage, such as peptic ulcer disease or postoperative infection. The clinical use of methylprednisolone in relieving dysphagia and decreasing PSTS deserves consideration during the early postoperative period.     

Early dysphagia complicating anterior cervical spine surgery: incidence and risk factors

Background

Dysphagia is a common complication of anterior cervical spine surgery, and most of them occurred in the early postoperative period. This study aimed to determine the incidence of early dysphagia after anterior cervical spine surgery and to identify its risk factors.

Methods

A review of 186 consecutive patients undergoing anterior cervical spine surgeries in a 3-year period was performed. Dysphagia at postoperative 1 month was surveyed, and the severity of dysphagia was evaluated. Demographic information and procedural characters were collected to determine their relationships to dysphagia.

Results

A total of 50 patients developed early postoperative dysphagia, including 23 males and 27 females. The incidence of early dysphagia after anterior cervical spine surgery was 26.9 % in this study. Mild, moderate, and severe dysphagia were found in 30, 14, and 6 patients, respectively. Female, advanced age, multi-levels surgery, use of plate, and a big protrusion of plate were found to be significantly increased early dysphagia after anterior cervical spine surgery.

Conclusion

There is a relatively high incidence of early dysphagia after anterior cervical spine surgery, which may be attributable to multiple factors.     

颈椎椎前软组织测量对颈椎损伤诊断的局限性

目前对于颈椎椎前软组织阴影放射学测量的诊断学价值尚存在不同意见.作者对107名颈椎损伤患者的颈椎X线片进行回顾性分析,结果有47例出现颈椎椎前软组织阴影增宽,占43.9%.其中颈椎骨性损伤患者中有38例,非骨性损伤患者中有9例,其差异具有显著的统计学意义(P<0.05).在不同节段颈椎损伤以及不同程度脊髓损伤患者之间统计学差异均不显著(P>0.05).而在颈椎前部结构损伤患者中椎前软组织阴影增宽的比例则明显高于后部结构损伤患者(P<0.05).作者认为,颈椎椎前软组织的放射学测量对于颈椎损伤的诊断显然具有一定的局限性.     

经食管床与经胸骨后上提路径行管状胃食管吻合术后患者生活质量的比较研究

目的比较经食管床与经胸骨后两种上提路径行管状胃食管颈部吻合术后患者的生活质量。方法前瞻性纳入2008年7月至2012年6月问汕头市中心医院收治的、拟行食管癌切除术的167例患者，按随机数字表法随机分为食管床路径组（85例）和胸骨后路径组（82例）。分别于术后1、3、6、9及12月进行生活质量问卷调查。结果除吻合口狭窄发生率食管床路径组低于胸骨后路径组外（P〈0．05），两组患者围手术期一般情况的差异均无统计学意义（均P〉0．05）。149例患者完成了术后生活质量问卷调查，食管床路径组术后吞咽梗阻和吞咽干呕两项症状明显优于胸骨后路径组，但反酸和烧心两项症状则相对更严重（均P〈0．05）。两组患者总体生活质量评分的差异并无统计学意义（P〉0．05）。结论经食管床路径和经胸骨后路径行管状胃食管吻合术用于食管癌切除术后消化道重建均可获得较好的术后生活质量。前者术后吞咽功能优于后者，但反流症状却更为显著，因此，两种吻合方式各有利弊，应根据临床经验及患者情况进行选择。     

气管推移训练对颈椎前路减压植骨融合内固定术术后康复影响的研究

目的 探讨术前气管推移训练对颈椎前路减压植骨融合内固定术的患者术后并发症及术后康复的影响。方法 回顾性分析江门市中心医院2017年1月到2021年7月行颈椎前路减压植骨融合内固定术的患者205例的临床资料,其中行单节段颈椎前路减压植骨融合内固定术的患者122例,行双节段颈椎前路减压植骨融合内固定术的患者83例。单节段患者中62例为术前气管推移训练组,60例为对照组。双节段患者中45例为气管推移训练组,38例为对照组。观察和分析的指标包括术后饮水呛咳、声音嘶哑、咽喉疼痛时间、咽喉疼痛程度、术后声音嘶哑及术后吞咽困难。结果 205例患者全部顺利完成手术,无患者死亡。在单节段颈椎前路减压植骨融合内固定术的患者中,气管推移训练组和对照组在术后饮水呛咳、术后声音嘶哑、术后吞咽困难等方面的差异无统计学意义（P>0.05）,但气管推移训练组比对照组术后咽喉疼痛的时间更短,术后咽喉疼痛的程度更轻（P<0.05）。在双节段颈椎前路减压植骨融合内固定术的患者中,气管推移训练组比对照组发生术后饮水呛咳、声音嘶哑、吞咽困难的患者更少（P<0.05）,术后咽喉疼痛的时间更短、程度更轻（P<0.05）。结论 颈椎前路减压植骨融合内固定术的患者术前进行气管推移训练有利于患者术后的术后快速康复,增强患者的术后舒适感,尤其对双节段颈椎前路减压植骨融合内固定术的患者更加明显。