食管癌贲门癌切除术两种重建方法对比分析

目的：探讨食道癌贲门癌术后两种重建方法的优劣。方法：实验组食管癌贲门癌切除术后采用圆形吻合器行食管胃器械吻合，吻合154号丝线间断加强并另行吻合口大网膜缠绕并吻合合口减张。对照组行食管胃粘膜及粘膜下分层吻合加胃浆肌层与食管肌层缝合包埋吻合口并减张重建。比较两组手术时间，术后肺部感染和肺不张、吻合口瘘和狭窄及胃食管反流发生率。结果：实验组吻合口瘘发生率为0．6％（2／316），吻合VI狭窄发生率为5．7％（18／316），对照组吻合口瘘发生率为1．6％（3／186），吻合口狭窄发生率为4．3％（8／186），均有显著性差异（P〈O．05）。吻合口近端胃食管反流液随机抽样检查pH值，差异无统计学意义（P〉0．05）。行机械吻合手术时间明显缩短，有统计学意义（P〈O．05）。实验组肺部感染发生率0．3％（1／316），无肺不张，对照组肺部感染发生率1．6％（3／186），肺不张0．5％（1／186），其差异有统计学意义（P〈O．05）。结论：食管癌贲门癌切除术中行机械吻合重建方便快捷，可减少并发症，适于临床临床推广。

Contrast Analysis on Two Reconstructive Methods after Resection of Esophageal and Cardiac Carcinoma

Objective：To compare the two reconstruction methods after resection of esophageal and cardiac carcinoma. Methods：Regular stapled anastomosis with circular mechanical staple after resection of esophageal and cardiac carcinoma was adopted to reconstruct cardia with thread marked 4 intervally to reinforce the anastomotjc ostium and with greater omentum winding the anastomotic region in experimental group. In contrast, in the control group, patients accepted anastomosis of esophageal mucosa and sub-mucosa with gastric counterparts, oblique invagination with gastric operation. The operation time, pulmonary infection and pulmonary atelectasis, the incidence of anastomotic leakage and anastomotic stricture and gastroesophageal reflux were compared. Results： In the experimental group the incidence of anastomotic leakage was 0.6 % （2/316）, anastomotic stricture 5.7 % （18/316 ）. In the control group the incidence of anastomotic leakage and anastomotic stricture were 1.6 % （3/186）and 4.3 % （8/186）, respectively. There was significant statistical difference（P〈0.05）. The time of operation in the experimental group was significantly shorter than that in control group（P〈0.05）. In the experimental group the incidence of pulmonary in- fection was 0.3 % （1/316）, no pulmonary atelectasis occurred, and in the control group the incidence of pulmonary infection and pulmonary atelectasis were 1.6 % （3/186 ） and 0.5 % （ 1/186 ） respectively （ P 〈 0. 05 ）. In the randomized examination the pH value at the gastro-esophageal anastomosis in the two groups showed no significant statistical difference（P〉0.05）. Conclusion：This stapled anastomosis operation is easy to handdle and can reduce the time of operation and has low rate of complication and can reduce anthropic factor. The clinical outcome is satisfactory.