管状胃在全胸腔镜食管癌手术中的应用

目的：探讨管状胃成形术在全胸腔镜下食管癌手术中应用的可行性和有效性。方法：回顾性分析2008年7月至2012年1月广东省揭阳市人民医院收治的行全胸腔镜下食管癌手术的49例患者的临床资料。患者均经右胸、腹、左颈行胸腔镜食管癌根治术＋胃代食管术，其中20例患者采用管状胃成形术重建上消化道（管状胃组），29例患者采用传统胸胃缝缩术（胸胃组）、，观察患者的手术时间、围手术期并发症等情况。结果：全组患者均顺利完成手术，无围手术期死亡。手术时间2．5～4．5h，平均手术时间（3．5±0．2）h。管状胃组患者围手术期的总并发症发生率，肺不张、心律失常发生率低于胸胃组（P〈0．05）。随访6～32个月，平均随访（13．0±3．5）个月，胸胃组和管状胃组患者出现吻合口狭窄、反流性食管炎者分别为7例和1例、12例和2例。管状胃组患者术后未发生胸胃综合征、胃排空障碍和营养障碍。结论：在全胸腔镜治疗食管癌手术中应用管状胃成形术符合生理、解剖要求，操作简单、安全有效，创伤小，术后并发症少，可改善患者生命质量，提高其生存率。

Gastric tube for thoracoscopic esophageal surgery

Objective： To determine the feasibility and effectiveness of gastroplasty for thoraeoseopic esophageal surgery. Methods： We did a retrospective analysis on the clinical profiles of 49 patients who were admitted to Jieyang People＇ s Hospital between July 2008 and January 2012 for thoraeoseopic surgery of esophageal carcinoma. All patients received the combination of thoraeoseopie radical esophageetomy through the right chest wall, abdomen and left cervix and gastroesophagostomy, of whom 20 cases were treated with upper alimentary tract reconstruction via gastric tube （gastric tube group ） and 29 received traditional thoracogastric suture （suture group）. The duration of surgery, incidence of perioperative and postoperative complications were assessed. Results： All patients accomplished the surgeries. No death tool was reported perioperatively. The mean duration of surgery was （ 3.5 _＋ 0.2） hours （ range ： 2.5 to 4.5 hours）. The gastric tube group yielded lower incidence of total postoperative complications, atelectasis and cardiac arrhythnda as compared with suture group during the perioperative period （ all P 〈 0.05 ）. During the follow-up period of 6 to 32 months [ mean ： （13.0 ＋ 3.5 ） months] , 7 eases with anastomotic stenosis and a single case with reflux esophagitis were reported in suture group, and these figures were 12 and 2 eases in gastric tube group, respectively. Neither thoracic gastric syndrome nor gastric emptying dysfunction or malnutrition was reported in gastric tube group. Conclusion： Gastric tube for thoraeoscopie esophageal surgei7 is consistent with physiologic and anatomical features and is readily for operation. The safety, effectiveness, minor injury and low incidence of postoperative complications may be associated with improved quality of life and survival rate.