不同食管癌吻合方式的临床研究

目的　探讨新吻合方式和传统吻合方式对食管癌病人术后生活质量的影响。方法　全组 40 0例 ,随机分为A、B两组 ,均行左颈、右胸前外侧和上腹正中联合三切口食管胃三排无包套吻合术。A组 2 0 0例行食管断端弧形切割、胃半弧形切口胃部分粘膜食管吻合术 ;B组 2 0 0例按传统吻合方式即食管断端水平切割食管胃吻合术 ,两组进行术后几项观察指标的对照评估 :术后进食情况 ;吻合口大小及返流情况 ;餐前餐后食管液PH值测定 ;食管 2 4hPH值测定 ;食管测压分析 ;内镜活检。结果　全组发生吻合口瘘 13例 ( 3 2 5 % ) ,胸腔感染 5例 ,死亡 3例 (A组 2例 ,死 1例 ;B组 3例 ,死 2例 )。除食管测压分析显示A、B两组间无差异外 ,其他各项观察指标均显示两组间有显著性差异 ( P <0 0 1)。结论　新的吻合方式较传统吻合方式明显提高了术后病人的生活质量。

Clinical Study of the Amputation Method of Esophageal Cancer Surgery Therapy

Objective To compare the effect of the new and traditional anastomotic modes on the life quality of the patients with esophageal cancer. Methods 400 cases of the patients with esophageal cancer were randomly divided into A and B group. All the patients received the anastomosis of the no imbedding with 3 rows suture through the pathway of thoracotomy allied with left neck,anteriolateral surface of right thorax and the epigastrium middle line. In group A the patients received the anastomosis with esophageal arc amputation and gastric half-arc amputation. In group B the patients received the traditional anastomosis with esophageal horizontal amputation. After operation the amount of taking foods, the width of anastomotic stoma, the amount of barium reflux, pH value of esophagorrhea, 24 hours pH value of esophagorrfea and intraesophageal pressure were measured in both the two groups patients. Results 13 cases of anastomotic fistula happened in all the patients, amounted to 3.25%. 5 cases had infection in the chest with 3 cases dead (1 from Group A, 2 from group B).All obove indices showed remarkable difference between the two groups of the patients except intraesophageal pressure. Conclusion The new anastomotic mode can improve the life quality of the patients with esophageal cancer much more than the traditional anastomotic mode.