食管活瓣成形-胃食管套接术预防食管癌术后吻合口并发症的效果分析

目的：明确食管活瓣成形‐胃食管套接术预防食管癌术后吻合口并发症的效果。方法预先设计了一项随机对照试验，纳入2010年1月至2013年6月共394例食管癌患者。该项研究已在中国临床试验中心注册，并获得了注册号：ChiCTR‐T RC‐13003817。有9例（2．3％）患者因未行食管癌根治术被排除，余下的所有患者均遵循随机分组的原则，随机分为两组，A组191例，B组194例。A组为试验组，术中接受食管活瓣成形‐胃食管套接吻合，而B组为对照组，术中接受常规器械吻合。比较两组术后并发症发生情况。结果术后吻合口瘘的发生率在A组和B组分别为4．1％和3．6％，差异无统计学意义（ P＝0．768）。在观察术后吻合口狭窄时有7例患者因术后死亡而失访。在剩下的病例中，观察到A组和B组术后吻合口狭窄发生例数分别为13例（6．9％）和25例（13．2％），差异有统计学意义（ P＝0．044）。此外对于术后胃食管返流的监测发现，A组和B组术后返流性食管炎和Barrett食管的例数分别为54例（28．7％）和105例（55．3％），差异有统计学意义（P＜0．01）。结论食管活瓣成形‐胃食管套接术能有效预防术后胃食管返流的发生，同时也能降低术后吻合口狭窄的发生率。

Esophageal valve forming esophageal and gastric sleeve joint surgery for preventing postoperative anastomotic complications of esophageal cancer

Objective To clarify the effect of esophageal valve forming esophageal and gastric sleeve joint surgery for preven‐ting postoperative anastomotic complications of esophageal cancer .Methods A randomized controlled trial was designed to incorpo‐rate a total of 394 patients with esophageal cancer from January 2010 to June 2013 .This study has been registered in the Chinese clinical trial center and received a registration number :ChiCTR‐TRC‐13003817 .Among them ,9 cases (2 .3% ) were excluded be‐cause of the non line esophageal cancer radical operation .The remaining patients were randomly divided into two groups ,191 cases in group A and 194 cases in group B ,according to the principle of random grouping .Group A was experimental group ,patients ac‐cepted esophageal valve forming esophageal and gastric sleeve joint surgery ,and group B was the control group ,patients received conventional anastomosis .Results The incidence of anastomotic leakage after operation in group A and group B were 4 .1% and 3 .6% ,thse results were not statistically significant (P=0 .768) .In the observation of anastomotic stenosis ,7 patients died after sur‐gery .In the remaining cases ,there were 13 cases (6 .9% ) and 25 cases (13 .2% ) in group A and group B ,respectively ,the differ‐ence was statistically significant (P=0 .044) .Furthermore ,reflux oesophagitis and Barrett′s epithelium were found in 105 patients (55 .3% ) in group B ,and 54 (28 .7% ) patients in group A ,the difference was statistically significant (P<0 .01) .Conclusion E‐sophageal valve forming esophageal and gastric sleeve joint surgery can effectively prevent postoperative gastroesophageal reflux , but also can reduce the postoperative incidence of anastomotic stenosis .