胸腹腔镜食管胃颈部吻合术胃经不同上提路径术后并发症的比较

目的探讨胸腹腔镜食管胃颈部吻合术管状胃经胸骨后与食管床不同上提路径对患者术后的影响。方法回顾性分析2009年3月至2013年10月在我院胸外科行胸腹腔镜食管癌切除、食管胃颈部吻合术58例患者的围手术期临床资料,其中采用胸骨后路径者35例,食管床路径者23例。结果经胸骨后路径组胃液引流量(312.5±69.7)ml]明显少于食管床路径组(832.7±132.6)ml,P<0.05]。两组患者术中出血量、手术时间、住院时间的差异无统计学意义(P>0.05);经胸骨后与食管床路径术后吻合口瘘(14.3%vs.8.7%)、肺部感染(8.6%vs.17.4%)等并发症发生率的差异均无统计学意义(P>0.05)。结论经胸骨后路径者术后胃液引流量少于经食管床路径者。经胸骨后与食管床不同胃上提路径行食管胃颈部吻合术均是可行的消化道重建方式,应根据临床经验及患者情况选择手术方式。

Comparison of postoperative complications after retrosternal and prevertebral gastric tube reconstruction during thoracoscopy and laparoscopy cervical esophago-gastric anastomosis

Objective To compare clinical outcome after thoracoscopy and laparoscopy cervical esophiga-gastric anastomosis with retrosternal and prevertebral gastric tube reconstruction. Methods A total of 58 patients who underwent thoracoscopy and laparoscopy esophagectomy and cervical anastomosis between March 2009 and October 2013 were enrolled in the study, including 35 patients in retrosternal group and 23 patients in prevertebral group. The clinical data were evaluated for analysis. Results Gastric fluid volume was significantly less in retrosternal group（312.5±69.7） ml] than in prevertebral group （832.7±132.6） ml, P〈0.05]. There were no significant differences between the retrosternal group（n=35） and the prevertebral group（n=23） with regard to operative bleeding, length of operation hospital stay, and postoperative complications, including anastomotic leak（14.3% vs. 8.7%） and pneumonia（8.6% vs. 17.4%）. Conclusions Gastric fluid volume was significantly less in retrosternal group than in prevertebral group（P〈0.05）. Retrosternal and prevertebral routes for gastric tube reconstruction are both acceptable methods in esophagectomy. Individualized reconstruction route should be considered based on clinical experience and patient＇s condition.