兜底式食管胃吻合术的临床应用研究

摘要：目的评价兜底式食管胃吻合术对吻合口瘘、吻合口狭窄和胃食管反流的预防作用及效果，探讨蒙特利尔定义“胃食管反流病”诊断流程、标准在食管重建术后的实用价值和意义。方法回顾性分析2007年6月至2011年6月笔者医院采用两种术式共行食管癌和贲门癌切除1078例的临床资料，参考相关诊断标准制表，问卷调查两组患者术后吻合VI狭窄和胃食管反流的发病情况。试验组（兜底式食管胃吻合术）582例，男403例、女179例，年龄（60．4±12．6）岁。食管癌399例，贲门癌183例，弓上吻合392例，弓下吻合190例。对照组（传统食管胃端侧吻合术）496例，男343例、女153例，年龄（59．2±12．8）岁。食管癌322例，贲门癌174例，弓上吻合317例，弓下吻合179例。结果与传统食管胃端侧吻合术相比，兜底式吻合术后吻合VI瘘的发生率较低[0％（0／582）VS．1．0％（5／496），x2=5．835，P=O．016）]；胃食管反流症状亦较轻，而伴有食管外症状及需要服用制酸剂患者则更少[1．6％（33／541）VS．12．6％（57／453），矿=23．564，P=O．000]，术后吻合口狭窄率各为0．9％（5／539）和7．3％（34／465）（x2=25．124，P=O．000），尤其是重度吻合I=I狭窄的发生率更低[0％（0／539）VS．4．7％（22／465），X2=24．883，P=O．000]。两组5年生存率差异无统计学意义。结论兜底式吻合法在预防食管胃吻合VI瘘、吻合VI狭窄和胃食管反流的发生方面较传统术式为优；蒙特利尔定义胃食管反流诊断流程和标准适合于食管重建术后胃食管反流之诊断。

Clinical Application of Pocket Esophagogastric Anastomosis after Esophagectomy

Objective To evaluate preventive effectiveness of pocket esophagogastric anastomosis for postoperative anastomotic leak, stricture and gastroesophageal reflux disease （GERD）, and investigate clinical significance of Montreal definition and classification of GERD after esophageal reconstruction. Methods Clinical data of 1 078 patients who received 2 different surgical procedures for resection of esophageal or cardiac carcinoma from June 2007 to June 2011 in our hospital were retrospectively analyzed. In the experimental group, there were 582 patients who received pocket esophagogastric anastomosis, including 403 male and 179 female patients with their age of 60.4_ 12.6 years. There were 399 patients with esophageal carcinoma and 183 patients with cardiac carcinoma, 392 patients receiving esophagogastrostomy above the aortic arch and 190 patients receiving esophagogastrostomy below the aortic arch respectively. In the control group, there were 496 patients who received conventional end-to-side esophagogastric anastomosis, including 343 male and 153 female patients with their age of 59.2 _4-12.8 years. There were 322 patients with esophageal carcinoma and 174 pa- tients with cardiac carcinoma, 317 patients receiving esophagogastrostomy above the aortic arch and 179 patients receiving esophagogastrostomy below the aortic arch respectively. A survey questionnaire was made on the basis of relevant diagnostic standards to investigate the incidence of postoperative anastomotic stricture and GERD of the 2 groups during follow-up. Results The incidence of postoperative anastomotic leak of the experimental group was significantly lower than that of the control group E 0% （0/582）versus 1.0% （5/496）, x2=5.835, P=0.016 I. Patients in the experimental group had less severe GERD symptoms, and the percentage of patients who needed antacid therapy for extraesophageal symptoms of GERD of the experimental group was significantly lower than that of the control group [ 1.6% （33/541 ） versus 12.6% （57/453）, x2= 23.564, P=-0.000 ]. The incidence of anastomotic stricture of the experimental group was significantly lower than that of the