不同吻合位置在胸腹腔镜食管癌切除术中的应用

目的 探讨不同吻合位置在胸腹腔镜联合食管癌（EC）切除手术中的应用效果及并发症发生情况。方法 回顾性分析2012 年3 月-2017 年4 月该院336 例EC 手术患者，根据术中管状胃吻合口的位置分为前壁组、后壁组及侧壁组（胃底大弯侧）。总结3 组术后吻合口瘘、吻合口狭窄及短期并发症发生率等，分析不同吻合位置对EC 切除术后并发症的影响。结果 3 组的吻合口狭窄、反流性食管炎比较，差异无统计学意义（P >0.05）；侧壁组的吻合口瘘、残端或胸胃瘘及切口感染发生率低于前壁组和后壁组（P <0.05）。前壁组死亡5 例（4.24%），后壁组死亡4 例（3.77%），侧壁组死亡1 例（0.89%）；3 组比较差异有统计学意义（P <0.05）。结论 选择管状胃侧壁吻合有利于降低吻合口并发症的发生率，该技术能有效保证吻合口的安全性，特别是术后吻合口瘘、残端或胸胃瘘等，具有很好的推广应用价值。

Application of different anastomosis sites in thoracoscopic andlaparoscopic esophagectomy

Objective To evaluate the application effects and complications of different anastomosis sites inthoracoscopic and laparoscopic esophagectomy. Methods Totally 336 Patients with thoracoscopic and laparoscopicesophagectomy form March 2012 to April 2017 were retrospectively included. According to the anastomosis sites ofthe tubular stomach, they were divided into 3 the anterior wall group, the posterior wall group and the (the greatercurvature side of stomach). Incidence of anastomotic fistula, anastomotic stenosis and short-term complications wereconcluded and the effects of different anastomosis sites on the complications of esophageal cancer were analyzed.Results There were no statistically significant differences (P > 0.05) in the three groups at aspects of stricture ofanastomotic stoma and reflux esophagitis. But the incidences of anastomotic fistula, residual or thoracic fistula, andinfection rate were significantly lower in lateral wall groupthan two other groups (P < 0.05). There were 5 deadcases in anterior wall group (4.24%), 4 dead cases in back wall group (3.77%) and 1 dead case in lateral wall group(0.89%), differences were statistically significant among the 3 groups (P < 0.05). Conclusion Anastomosis in lateralwall can significantly reduce the incidence rate of anastomotic complications (especially for anastomotic fistula,residual or thoracic fistula), which guarantees the security of the anastomosisand has great application value.