胃食管吻合及浆肌层内翻缝合包埋处理对食管癌患者术后并发症的影响研究

目的 探讨胃食管吻合及浆肌层内翻缝合包埋处理对食管癌患者术后并发症的影响.方法 选取接受治疗且手术前确诊为食管癌,并行食管癌切除和胃食管吻合手术的患者177例,其中65例患者行单纯胃食管吻合术,设为对照组;112例患者在胃食管吻合术基础上进行吻合口浆肌层的内翻缝合包埋,设为观察组;比较两组患者手术后切口感染、吻合口瘘、肺部感染、喉返神经受损和乳糜胸发生情况,手术后1个月食管X线钡餐检测测量吻合口狭窄、吻合口直径和反流反酸、吞咽困难的评分状况.结果 术后观察组患者吻合口直径小于对照组,吻合口狭窄发生情况多于对照组,差异均有统计学意义(P﹤0.05);两组患者术后并发症发生情况及围手术期内死亡情况比较,差异均无统计学意义(P﹥0.05);对照组患者术后吞咽困难评分优于观察组,差异有统计学意义(P﹤0.05),两组患者反流反酸评分比较,差异无统计学意义(P﹥0.05).结论 吻合口浆肌层内翻缝合包埋对防止出现吻合口瘘没有临床意义,无法使患者术后吻合口瘘发生率降低,同时使术后出现吻合口狭窄的概率增大.

Effect of embedded esophagogastric anastomosis and seromuscular inverting suture on the postoperative complications in esophageal cancer patients after surgery

Objective To investigate the impact of embedded esophagogastric anastomosis and seromuscular invert-ing suture on the postoperative complications in esophageal cancer patients after surgery.Method 177 cases who under-went esophagectomy and esophagogastric anastomosis that were confirmed as esophageal cancer before surgery were ana-lyzed,including 65 cases that had simple esophagogastric anastomosis as control group,and 112 cases who were adminis-tered with embedded seromuscular inverting suture on the basis of esophagogastric anastomosis as study group;the two groups of patients were compared for the incidence of postoperative wound infection,anastomotic fistula,pulmonary in-fection,recurrent laryngeal nerve injury and the occurrence of postoperative chylothorax;barium X ray was administered 1 month after surgery to measure the score of anastomotic stenosis,anastomotic diameter,regurgitation,and dysphagia.Result The anastomotic diameter was smaller in study group than in control group,while the anastomotic stenosis was more in study group than in control group,the difference was statistically significant (P<0.05);the incidence of postopera-tive complications and the number of perioperative deaths were comparable between the two groups,with no statistically significant difference observed (P>0.05);the patients in the control group had better postoperative dysphagia scores than the study group,showing statistically significant difference (P<0.05).But there was no significant difference regarding the regurgitation score between the two groups (P>0.05).Conclusion It is of no clinical significance to administer the embedded seromuscular inverting suture for the sake of preventing anastomotic leakage,which does not reduce the inci-dence of anastomotic stomatitis,but will increase the chance of anastomotic stenosis.