食管癌切除术颈部机械吻合与手工吻合的疗效分析
Efficacy of circinal stapled suture and manual suture in cervical esophagogastric anastomosis in esophageal resection
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摘要:
目的 评价机械吻合与手工吻合在食管癌切除术颈部吻合中的应用价值。
方法 本研究回顾性分析2010年1月至2012年1月四川省肿瘤医院收治的187例食管癌患者的临床资料，根据行食管癌切除术后颈部吻合的方式不同分为机械吻合组(98例)和手工吻合组(89例)，比较两组患者吻合时间、总手术时间、术后开始进食时间、住院时间、术后并发症发生率及食管残端癌阳性率的差异，计量资料采用t检验，计数资料采用χ2检验或Fisher确切概率法。
结果 机械吻合组患者吻合时间、总手术时间、术后开始进食时间及住院时间分别为(7.8±1.4 )min、(227±60)min、(6.3±0.9)d、(14±4)d，短于手工吻合组的(28.5±2.3)min、(301±81)min、(8.4±1.0)d、(22±9)d，两组比较，差异有统计学意义（t=75.44，7.14，7.71，7.41，P＜0.05)；机械吻合组患者术后吻合口瘘发生率为1%(1/98)，低于手工吻合组的8%(7/89)，两组比较，差异有统计学意义(P<0.05)；两组吻合口狭窄发生率分别为5%(5/98)和7%(6/89)，两组比较，差异无统计学意义(P>0.05)；机械吻合组无食管残端癌，手工吻合组食管残端癌阳性率为4%(4/89)，两组比较，差异有统计学意义(P<0.05)。
结论 机械吻合在食管癌颈部吻合中不仅能缩短吻合时间、总手术时间及住院时间，而且能降低吻合口瘘发生率和食管残端癌阳性率。Abstract:Objective To evaluate the efficacy of circinal stapled suture and manual suture in cervical esophagogastric anastomosis in esophageal resection.
Methods The clinical data of 187 patients with esophageal cancer who were admitted to the Cancer Hospital of Sichuan Province from January 2010 to January 2012 were retrospectively analyzed. All the patients were divided into the stapled suture group (98 patients) and manual suture group (89 patients). The time of anastomosis, operation time, time for dieting, duration of hospital stay, the incidence of postoperative complications and positive rate of esophageal remnant cancer cells of the 2 groups were compared. All data were analyzed using the t test or chi-square test.
Results The time of anastomosis, operation time, time for dieting and duration of hospital stay were (7.8±1.4)minutes, (227±60)minutes, (6.3±0.9)days and (14±4)days in the stapled suture group, which were significantly shorter than (28.5±2.3)minutes, (301±81)minutes, (8.4±1.0)days and (22±9)days in the manual suture group (t=75.44, 7.14, 7.71, 7.41, P<0.05). The incidence of anastomotic fistula was 1%(1/98) in the stapled suture group, which was significantly lower than 8%(7/89) of the manual suture group (P<0.05). The incidence of anastomotic stricture was 5%(5/98) in the stapled suture group, which was lower than 7%(6/89) in the manual suture group, but no significant difference was detected (P>0.05). The positive rate of esophageal remnant cancer cells was 0(0/98), which was signifiantly lower than 4%(4/89) in the manual suture group (P<0.05).
Conclusion Circinal stapled suture in esophagogastric cervical anastomosis not only reduce the time of anastomosis, operation time and duration of hospital stay, but also decrease the incidence of anastomotic fistula and the positive rate of esophageal remnant cancer cells.
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