管状胃在食管贲门癌手术中的临床应用

目的：评价管状胃技术在食管、贲门癌患者根治手术中的临床效果。方法：选取2007年5月-2010年12月我院胸外科收治的食管、贲门癌214例,按手术方法分为管状胃组和对照组,管状胃组：118例,男99例,女19例,年龄58.81±8.39岁（38-80岁）。其中食管癌104例于左颈部吻合49例,弓上吻合32例,弓下吻合23例;贲门癌根治14例。对照组：96例,男74例,女22例,年龄58.54±9.05岁（27-80岁）。食管癌89例于左颈部吻合8例,主动脉弓上吻合56例,弓下吻合25例;贲门癌根治7例。观察两组术后吻合口瘘发生率、手术时间、住院时间等。结果：两组均顺利完成手术。管状胃组发生吻合口瘘1例,残胃瘘7例;对照组发生吻合口瘘4例,残胃瘘1例;手术时间管状胃组与对照组（257.77±79.77 min vs 244.26±63.68 min,t=1.342,P=0.181）,吻合口瘘（P〉0.05）及残胃瘘（P〉0.05）差异无统计学意义,术后住院时间（14.90±5.65d vs 17.20±8.49d,t=2.279,P=0.024）,胸胃综合症发生率（P〈0.05）差异有统计学意义。结论：管状胃操作简单、安全,胸胃综合症并发症发生率较低,不增加手术时间,缩短了住院时间,可改善患者术后生活质量,具有较好的临床应用价值。

A comparative study on substitution of esophagus with and without gastric tube in patients with carcinoma of the esophagus or gastric cardia

Objective：To observe the clinical effect of applying gastric tube in radical resection of the carcinoma of esophageal or gastric cardia.Methods： From May 2007 to December 2010,214 patients with carcinoma of esophageal or gastric cardia were divided into gastric tube group and control group.The gastric tube group was composed of 99 males and 19 females aged from 38 to 80 years old with an average of 58.81.The patients with esophageal carcinoma underwent gastroesophago-anastomosis at left neck in 49,at superior aortic arch in 32 and at inferior aortic arch in 23.Another 14 patients underwent radical resection of the carcinoma of gastric cardia.The control group composed of 74 males and 22 females aged ranged from 27 to 80 years old with an average age of 58.54.The patients with carcinoma of esophageal underwent anastomosis at left neckin 8,at superior aortic arch in 56 and at inferior aortic arch in 25.Another 7 patients underwent radical resection of the carcinoma of gastric cardia.The incidences of anastomotic leakage,operation time,hospitalization time were compared between two groups.Results： The surgery was successfully completed in all patients.There were one case of anastomotic leakage and 7 cases of remnant gastric leakagesin the gastric tube group,and 4 anastomotic leakages and 7 remnant gastric leakages occured in the control.There was no significant difference in operation time（257.77±79.77 min vs 244.26±63.68 min,t=1.342,P=0.181）,anastomotic leakage（P0.05）and remnant gastric leakage（P0.05）.But there were significant differences in the hospi-talization time post-operation（14.90±5.65 d vs 17.20±8.49 d,t =2.279,P=0.024） and the incidence of thoracic stomach syndrome（P 0.05）.Conclusion： Gastric tube has a good value in clinical application with better resection of tumor,fewer complications of thoracic stomach syndrome and without prolonging operation and hospitalization time.