管状胃在胸腹腔镜联合食管癌根治术中的应用探讨

目的探讨管状胃在胸腹腔镜联合食管癌根治术中的临床应用价值。方法选取2011年1月至2015年12月在我院行胸腹腔镜联合食管癌根治术治疗的胸段食管癌患者160例,将其分为两组,分别采用管状胃代食管手术和传统全胃缝缩术治疗。记录两组患者手术完成情况、比较两组患者淋巴结清扫个数、失血量、手术时间、胸管留置时间、术后引流量、围手术期和随访期间并发症发生率、记录并发症处理情况、比较两种手术方法的总体疗效。结果两种术式在胸部淋巴结清扫个数、术中失血量、胸管留置时间和术后引流量方面无明显差异(P0.05);管状胃代食管术手术时间、腹部淋巴结清扫个数明显多于全胃缝缩术(P0.05)。管状胃代食管术的并发症发生率明显低于全胃缝缩术(P0.05)。管状胃代食管术住院时间、术后进食时间、复发和转移率、2年生存率和生活质量均明显优于全胃缝缩术(P0.05)。两组1年生存率无明显差异(P0.05)。结论管状胃代食管术可有效减少食管癌术后并发症,提高患者生活质量和生存率,安全可靠。

Application of gastric tube in combined thoracoscopic-laparoscopic esophagectomy for treatment of esophageal carcinoma

【Abstract】 Objective To compare the results of combined thoracoscopic- laparoscopic and open esophagectomy performed for esophageal squamous cell carcinoma. Methods 160 patients with thoracic esophageal carcinoma from January 2011 and December 2015 in our hospital for treatment of radical resection of thoracic esophageal carcinoma combined with laparoscopy were divided into two groups，respectively，using the tubular gastric reflux surgery and traditional gastric closure treatment. Records of two patients completed surgery, compared two groups of patients with lymph node dissection number, operation time, blood loss, chest tube indwelling time, postoperative drainage, perioperative complications, and follow- up records of complications, comparison of two operative methods for total efficacy. Results Two kinds of operation in the thoracic lymph node dissection, intraoperative blood loss volume，the number of the chest tube drainage time and postoperative drainage had no significant difference（P>0.05）；gastric tube interposition surgery time, abdominal lymph node dissection significantly more than the number of total gastric closure （P<0.05）. The incidence rate of complications of tubular stomach replacement of esophagus was significantly lower than that of whole gastric suture （P<0.05）. The time of hospitalization， postoperative feeding time， recurrence and metastasis rate，two- year survival rate and quality of life （QOL）were significantly higher than that of whole gastric suture （P<0.05）. There was no significant difference in survival rate between the two groups（P>0.05）. Conclusion The treatment of esophageal cancer with esophageal tube can effectively reduce postoperative complications， improve the quality of life and survival rate of patients with esophageal cancer，and is safe and reliable.