大网膜纵隔移位固定对食管癌Ivor-Lewis术后胸内感染的预防

目的：探讨大网膜纵隔移位固定对食管癌Ivor-Lewis术后近期胸内感染并发症的预防价值。方法回顾性分析浙江大学医学院附属第一医院普通胸外科于2010年1月至2014年5月行Ivor-Lewis手术的148例食管癌患者的临床资料，其中行大网膜纵隔移位固定者84例（改良组），未行大网膜纵隔移位固定者64例（对照组），评估两组患者术后近期胸内感染发生情况。结果改良组和对照组分别为胸内感染发生率39．3％（33/84）和56．2％（36/64），其中合并出现败血症的比例分别为57．6％（19/33）和86．1％（31/36），差异均有统计学意义（均P＜0．05）。但两组患者住院期间吻合口瘘、切口感染和心脏并发症发生率和病死率的差异均无统计学意义（均P＞0．05）。术后住院时间改良组较对照组明显缩短（中位13．0 d比16．5 d，P＜0．05）。结论大网膜纵隔移植固定改良手术可显著降低食管癌患者术后胸内感染的发生率及严重程度。

Omental transposition to mediastinum improves the outcome of postoperative intra-thoracic infections of Ivor-Lewis surgery

Objective To study the efficacy of pedicled greater omentum transposed to mediastinum in prevention against postoperative in-hospital intrathoracic complications after esophagectomy. Methods Clinical data of 148 consecutive patients with esophageal cancer undergoing Ivor-Lewis surgery in our department from January 2010 to May 2014 were retrospectively reviewed. Among them, 84 patients with omental transposition （transposition group） and 64 patients without omental transposition（non-transposition group） were compared. Results Postoperative hospital stay was shorter in patients with omental transposition compared to those without omental transposition （P〈0.05）. Intrathoracic infection rate was significantly lower in transposition group （33/84, 39.3%） than that in non-transposition group（36/64, 56.2%）, and as was the combined sepsis rate19/33, 57.6%vs. 31/36, 86.1%, P〈0.05]. No significant differences were found in the morbidity of anastomotic leakage , wound infection, cardiac complication and mortality during hospitalization. The median postoperative hospital stay was significantly shorter in transposition group than that in non-transposition group （13.0 vs. 16.5 days, P〈0.05）. Conclusion Omental transposition to mediastinum can reduce the development and severity of intrathoracic infection and shorten hospital stay in patients undergoing esophagectomy.