管状胃代食管术在食管癌根治术后的疗效观察

目的 探讨管状胃代食管术在食管癌根治术后的治疗效果.方法 回顾性分析2013年6月至2015年6月在苏州大学附属第一医院确诊为食管癌的患者97例,其中51例采用管状胃代食管吻合术,作为管胃组;46例采用传统全胃代食管吻合术,作为全胃组.比较两组患者的手术时间、术中出血量、术后胃肠减压量、住院时间、病理分期及术后并发症发生情况等指标的差异.结果 两组患者均无围手术期死亡.管胃组手术时间长于全胃组(287.43±23.64) min:(266.13 ±26.47)min],差异具有统计学意义(t=2.279,P=0.031).管胃组胃肠减压量小于全胃组(1 908.14±327.97)ml:(2 221.93 ±323.87) ml],差异具有统计学意义(t=-2.591,P=0.015).管胃组和全胃组患者术中出血量(325.00 ±64.30) ml:(356.67±49.52)ml;t=-1.490,P=0.147]、淋巴结清扫数(10.73±4.83)枚:(10.36±5.31)枚;t=0.238,P=0.813]、术后住院时间(15.32±3.69)d:(16.45±3.80)d;t=-1.005,P=0.320]及术后病理分期(P=0.713)的差异均无统计学意义.管胃组胃食管反流的发生率低于全胃组,差异有统计学意义(1.96％:15.22％;x2=5.617,P=0.025).管胃组和全胃组患者吻合口瘘(5.88％:10.87％;x2 =0.795,P=0.471)、术后肺部并发症(13.73％:23.91％;x2=1.661,P=0.296)、吻合口狭窄(7.84％:13.04％;x2 =0.707,P=0.510)等的发生率差异无统计学意义.结论在食管癌的手术治疗中,管状胃代食管术优于全胃代食管术,有利于提高患者术后生命质量,值得临床推广.

Clinical observation of the tubular stomach substitute for esophagus anastomosis in the radical surgery of esophageal cancer

Objective To investigate the clinical treatment effect of tubular stomach substitute for esophagus anastomosis in the radical surgery of esophageal cancer.Methods Ninety-seven patients diagnosed with esophageal cancer in the First Affiliated Hospital of Soochow University from June 2013 to June 2015 were selected.They were divided into two groups,51 patients using the gastric tube substitute for esophagus anastomosis in the gastric tube group,and 46 patients using the traditional full stomach substitute for esophagus anastomosis in the whole stomach group.The operation times,intraoperative blood losses,the amount of postoperative gastrointestinal decompression,hospital stays,pathologic stages and incidences of complications after surgery in the two groups were observed and compared.Results There were no preoperative death in the two groups.The gastric tube group took more operating time than the whole stomach group (287.43 ± 23.64) min vs.(266.13 ±26.47) min],with a significant difference (t =2.279,P =0.031).In the comparison of the amount of gastrointestinal decompression,the gastric tube group was less than the whole stomach group (1 908.14 ±327.97) ml vs.(2 221.93 ± 323.87) ml],with a significant difference (t =-2.591,P =0.015).There were not significant differences in blood losses (325.00 ± 64.30) ml vs.(356.67 ± 49.52) ml;t =-1.490,P =0.147],the numbers of lymph nodes (10.73 ± 4.83) vs.(10.36 ± 5.31);t =0.238,P =0.813],hospital stays (15.32 ± 3.69) d vs.(16.45 ± 3.80) d;t =-1.005,P =0.320] and pathologic stages (P =0.713) in the gastric tube group and whole stomach group.The incidence of gastroesophageal reflux in the gastric tube group was significantly less than that in the whole stomach group,with a significant difference (1.96％ vs.15.22％;x2 =5.617,P =0.025).The occurrence of the complications like anastomotic leakage (5.88％ vs.10.87％;x 2=0.795,P =0.471),postoperative pulmonary complications (13.73 ％ vs.23.91％;x2 =1.661,P =0.296)and anastomotic stenosis (7.84％ vs.13.04％;x2 =0.707,P =0.510) had no statistical difference in the gastric tube group and whole stomach group.Conclusion In the surgical treatment of esophageal cancer,tubular stomach substitute for esophagus anastomosis is better than the full stomach substitute for esophageal surgery,which can improve the life quality of postoperative patients and is worthy of clinical promotion.