食管癌经膈食管韧带游离食管贲门部方法的临床研究

目的探索食管癌手术游离食管贲门部的新方法，以减少游离时间、出血量及术后吻合口瘘和狭窄等并发症的发生率。方法随机选取两组食管癌患者，A组（实验组，采用经膈食管韧带游离食管贲门部组）共36例（全部为中下段癌），行左开胸食管切除加胃代食管术；B组（对照组，采取一般方法游离食管贲门组）共49例，也行左开胸食管切除加胃代食管术。结果A、B两组患者在游离食管贲门部平均时间（A：（12±5）min；B：（34±3）min，P〈0．001）、术中出血（A：（50±6）ml；B：（165±10）ml，P〈0．001）、术后引流总量（A：（1526±62）ml；B：（1745±49）ml，P〈0．001）及术后平均住院时间（A：（7±1）d；B：（12±2）d，P〈0．001）有显著差异；术后心律失常（A：0／36；B：4／49，χ2=3．08）、近期吻合口瘘发生率（A：0／36；B：2／49，χ2=1．50）、随访1～24个月吻合口狭窄发生率（A：0／36；B：4／49，χ2=3．08）差异无显著性；而总并发症发生率（A：0／36；B：10／49，χ2=8．33，P〈0．001）差异有显著性。结论使用经膈食管韧带游离食管贲门部可明显缩短手术时间和减少食管切除术后并发症发生率。

Clinical study of the method of dissected esophageocardia juntion via esophageophrenic ligament in esophageal cancer

Objective To try to find out a new kind method of dissected esophageocardia juntion via esophageophrenic ligament in esophageal cancer so as to decrease operative time, amount of bleeding and incidences of complications of anastomotic leakage or stricture. Methods 85 patients suffering from esophageal carcinoma at middle or lower segment of esophagus were divided into two groups at random：the group A （36 patients）would have received esopbagectomy and esopbagogastrostomy, by using the method of dissected esophageocardia juntion via esophageophrenic ligament, while the group B （49 patients）had only been done by the common method, namely dissected esophageocardia juntion via ligament of gastrospleen. Results There were statistical significances between group A and B in the mean time of operation（ A ： 12 ± 5 min ; B ： 34 ± 3 min, P 〈 0. 001 ）, intra-operative amount of bleeding （ A ： （ 50 ± 6 ） ml ; B ： （ 165 ±10 ） ml, P 〈 0. 001 ）, total postoperative drainage （ A ： （ 1526 ± 62） ml ; B ： （ 1745 ± 49 ） ml, P = 0. 382 ） and mean postoperative days of hospitalization （ A ： （7 ± 1 ） d ; B ： （ 12 ± 2） d,P 〈 0. 001 ）, there were no statistical significances between the group A and B in the occurrence of arrhythmia postoperatively （ A ：0/36 ; B ：4/49, χ2 = 3.08 ）, incidence of anastomotic leakage postoperatively （ A ：0/36 ; B ：2/49,χ2 = 1.50） and the incidence of stricture by follows-up from one to twenty-four months （ A ：0/36 ; B ：4/49, χ2 = 3.08 ）, but there were also statistical signifi- canoes between the group A and B in the total incidence of complications（ A ：0/36 ; B ： 10/49, χ2= 8.33, P 〈 0. 001 ）. Conclusion Using the method of dissected esophageocardia juntion via phrenicoesophageal ligament can short remarkable the operation time and reduce occur- rence rate of complications postoperatively of radical esophagectomy.