食管癌三切口手术中管状胃两种不同上提径路的临床观察

目的观察食管癌三切口手术中,管状胃经食管床和胸骨后两种径路上提行胃食管颈部吻合的临床疗效。方法对揭阳市人民医院2006年6月-2011年6月间98例行食管癌三切口手术患者,随机分为A组(管状胃经食管床)和B组(管状胃经胸骨后)行管状胃上提完成胃食管颈部吻合。结果两组患者手术均顺利完成,无死亡病例,两组病例在手术时间,术中出血量,住院时间方面差异均无统计学意义(P>0.05)。而在吻合口瘘,肺部感染,肺不张,胸腔引流量方面上有明显差异,胸骨后径路组的吻合口瘘发生率(12.5%)明显高于食管床径路组(6.0%,P<0.01)。结论经胸骨后和经食管床径路管状胃上提均为安全、有效的途径;但胸骨后径路术后吻合口瘘发生率较高,而经食管床径路术后肺部感染,肺不张发生率较高,胸腔引流量较多。临床实际应用过程中应根据患者具体情况个体化选择管状胃的上提径路。

Clinical Observation of Retrosternal and Posterior Mediastinal Gastric Tube Reconstruction after Three-Phase Esophagectomy for Esophageal Carcinoma

Objective To compare the clinical efficacy between retrosternal and posterior mediastinal gastric tube reconstruction after three-phase esophagectomy for esophageal carcinoma.Methods A total of 98 patients who underwent three-phase esophagectomy between June 2006 and June 2011 were enrolled in this study,and were randomly allocated to group A(the posterior mediastinal group) and group B(the retrosternal group).Results All patients of both groups were operated successfully,no death case.There were no significant differences between two groups in operation time,intraoperative blood loss,hospital stays.Postoperative pneumonia,atelectasis and pleural fluid drainage were significantly different between two groups,Anastomotic leakage occurred more frequently in retrosternal group(12.5%) than that in posterior mediastinal group(6.0%),P<0.01.Conclusion After three-phase esophagectomy,both retrosternal and posterior mediastinal gastric tube reconstruction can be performed easily and safely.The rate of anastomotic leakage is higher in retrosternal reconstruction.The rate of postoperative pneumonia and atelectasis is higher in the posterior mediastinal group,and pleural fluid drainage is more.In order to select the suitable pathway to put in the gastric tube,it is necessary to consider the individual conditions of each patient.