改良自牵引Overlap法在Ivor Lewis手术食管胃胸内吻合中的应用价值

Application value of modified self-traction Overlap method in intrathoracic esophagogastrostomy of Ivor Lewis surgery

    摘要
  • 摘要: 目的:探讨改良自牵引Overlap法在Ivor Lewis手术食管胃胸内吻合中的应用价值。
    方法:采用回顾性描述性研究方法。收集2018年1—5月复旦大学附属中山医院收治的12例行Ivor Lewis手术的下段食管癌患者的临床资料；男9例，女3例；中位年龄为61岁，年龄范围为50～73岁。患者均采用改良自牵引Overlap法行食管胃胸内吻合，利用结扎线作为牵引，下拉食管，将食管顺时针旋转45°，行食管胃侧侧吻合，用腔镜直线切割闭合器关闭共同开口，形成食管胃Overlap三角形吻合口，最后离断食管。观察指标：(1)术中和术后情况。(2)随访情况。采用门诊和电话方式进行术后随访，随访内容为患者生存情况和肿瘤复发转移情况。随访时间截至2019年1月。计量资料采用M(范围)表示。
    结果:(1)术中和术后情况：12例患者均顺利完成Ivor Lewis手术，无中转开胸开腹。12例患者手术时间为145 min(125～ 189 min)，管状胃食管吻合时间为20 min(16～35 min)，术中出血量为98 mL(78～135 mL)，术后首次肛门排气时间为4 d(3～5 d)，术后恢复进食流质食物时间为6 d(5～7 d)。患者均未出现并发症，术后5 d均行上消化道碘水造影检查，未发现吻合口漏和吻合口狭窄。患者术后均恢复良好出院，术后住院时间为8 d(7～11 d)。(2)随访情况：12例患者均获得随访，随访时间为8.0～12.0个月，中位随访时间为10.6个月。患者均生存良好，未出现肿瘤复发和转移。
    结论:Ivor Lewis手术中采用改良自牵引Overlap法行食管胃胸内吻合操作简便，安全可行。

     

    Abstract: Objective:To explore the application value of modified self-traction Overlap method in intrathoracic esophagogastrostomy of Ivor Lewis surgery.
    Methods:The retrospective and descriptive study was conducted. The clinical data of 12 patients with lower esophageal carcinoma who underwent Ivor Lewis surgery in the Zhongshan Hospital of Fudan University from January to May 2018 were collected. There were 9 males and 3 females, aged from 50 to 73 years, with a median age of 61 years. Modified self-traction Overlap method was used for intrathoracic esophagogastrostomy during the surgery. The esophagus was pulled down with the ligature as traction and rotated clockwise by 45 degrees to perform side-to-side esophagogastric anastomosis. The common opening was closed by a laparoscopic linear cutting suturing device to form an esophagogastric Overlap triangle anastomosis, and finally the esophagus was disconnected. Observation indicators: (1) intraoperative and postoperative situations; (2) followup situations. Followup using outpatient examination and telephone interview was performed to detect survival situation and tumor recurrence and metastasis up to January 2019. Measurement data were described as M (range).
    Results:(1) Intraoperative and postoperative situations: all the 12 patients underwent successful Ivor Lewis surgery, without conversion to open surgery. The operation time, time of tubular gastroesophageal anastomosis, volume of intraoperative blood loss, time to initial anal exsufflation and time for initial fluid diet intake were 145 minutes (range, 125-189 minutes), 20 minutes (range, 16-35 minutes), 98 mL (range, 78-135 mL), 4 days (range, 3-5 days), 6 days (range, 5-7 days), respectively. All the patients had no complication. Patients underwent upper gastrointestinal iodine hydrography at 5 days after surgery, confirming no anastomotic leakage or stenosis. Patients recovered well and were discharged postoperatively. The duration of postoperative hospital stay was 8 days (range, 7-11 days). (2) Followup situations: 12 patients were followed up for 80-120 months, with a median time of 106 months. Patients survived well, with no tumor recurrence or metastasis.
    Conclusion:Modified self-traction Overlap method in thoracic esophagogastrostomy of Ivor Lewis surgery is safe and feasible for lower esophageal carcinoma, with easy operating

     

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