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管状胃在食管贲门癌手术中的临床应用 付军科,等 管状胃在食管贲门癌手术中的临床应用
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付军科 ,张勇 ,李新举 ,陈 健 ,张广健 ,吴齐飞 ,王 哲 ,杨晓梅
A comparative study off substitution of esophagus with and without gastric tube in pa-
tients with carcinoma of the esophagus or gastric cardia
FU Junke ,ZHANG Yong ,LI Xinju ,CHEN Jian ,ZHANG Guangjian ,WU Qifei ,WANG Zhe ,YANG
Xiaomei
Department of Thoracic Surgery,the First Affiliated Hospital ofMedical Colledge,Xi"an Jiaotong University,Shaanxi ,nn 710061,Chi—
na; Hospital 521 ofChina's Ordnance Industry Group,Shaanxi Xi"an 710065,China. 【Abstract】 Objective:To observe the clinical effect of applying gastric tube in radical resection of the carcinoma of
esophageal or gastric cardia.Methods:From May 2007 to December 2010,214 patients with carcinoma of esophageal
or gastric cardia were divided into gastric tube group and control group.The gastric tube group was composed of 99
males and 19 females aged from 38 to 80 years old with an average of 58.81.rI’he patients with esophageal carcinoma
underwent gastroesophago—anastomosis at left neck in 49,at superior aortic arch in 32 and at inferior aortic arch in
23.Another 14 patients underwent radical resection of the carcinoma of gas ̄ic cardia.The control grouD composed of 74 males and 22 females aged ranged from 27 to 80 years old with an average age of 58.54.The patients with carci—
noma of esophageal underwent anastomosis at left neekin 8,at superior aortic arcb in 56 and at inferior aortic arch in
25. Another 7 patients underwent radical resection of the carcinoma of gastric cardia.The incidences of anastomotic
leakage,operation time,hospitalization time were compared between two groups.Results:The surgery was successful—
ly completed in all patients.There were one case of anastomotic leakage and 7 cases of remnant gastric leakagesin the
gastric tube group,and 4 anastomotie leakages and 7 remnant gastric leakages occured in the contro1.There was no significant diference in operation time(257.77.4-79.77 min vs 244.26-4-63.68 min,t=1.342,P=0.181).anasto—
motic leakage(P>0.05)and remnant gastric leakage(P>0.05).But there were significant differences in the
hospi—talization time post—operation(14.90.4-5.65 d vs 17.20±8.49 d,t=2.279,P=0.024)and the incidence
【收稿日期】 【修回Et期】 【作者单位】
【作者简介】 2012—.04— 17
2012——05—.03 西安交通大学医学院第一附属医院胸外科,陕西西安710061 中国兵器工业五二一医院内二科,陕西西安710065 付军科(1964一),男,陕西岐山人,副主任医师,博士,硕士生导师,主要从事食管癌及肺癌相关研究。 1J 1J 1J 1J 1j
医学2012年10月第20卷第10期 MODERN ONCOLOGY.0ct.2012.VOL.20.NO.10 ・2073・
of thoracic stomach syndrome(P<0.05).Conclusion:Gastric tube has a good value in clinical application with bet— ter resection of tumor,fewer complications of thoracic stomach syndrome and without prolonging operation and hospi—
talization time. 【Key words】esophageal carcinoma;cardial carcinoma;gastric tube
Modern Oncology 2012,20(10):2072—2074
【摘要】 目的:评价管状胃技术在食管、贲门癌患者根治手术中的临床效果。方法:选取2007年5月一2010
年12月我院胸外科收治的食管、贲门癌214例,按手术方法分为管状胃组和对照组,管状胃组:118例,男99
例,女19例,年龄58.81±8.39岁(38—80岁)。其中食管癌104例于左颈部吻合49例,弓上吻合32例,弓下
吻合23例;贲门癌根治14例。对照组:96例,男74例,女22例,年龄58.54±9.05岁(27—80岁)。食管癌
89例于左颈部吻合8例,主动脉弓上吻合56例,弓下吻合25例;贲门癌根治7例。观察两组术后吻合口瘘发 生率、手术时间、住院时间等。结果:两组均JJ ̄,J完成手术。管状胃组发生吻合口瘘1例,残胃瘘7例;对照
组发生吻合口瘘4例,残胃瘘1例;手术时间管状胃组与对照组(257.77 4-79.77 rain VS 244.26±63.68 min,t
=1.342,P=0.181),吻合口瘘(P>0.05)及残胃瘘(P>0.05)差异无统计学意义,术后住院时间(14.90±
5.65d VS 17.20±8.49d, =2.279,P=0.024),胸胃综合症发生率(P<0.05)差异有统计学意义。结论:管状
胃操作简单、安全,胸胃综合症并发症发生率较低,不增加手术时间,缩短了住院时间,可改善患者术后生活
质量,具有较好的临床应用价值。
【关键词】食管癌;贲门癌;管状胃
【中图分类号】R735.1 【文献标识码】A DOI:10.3969/j.issn.1672—4992.2012.10.25
【文章编号】1672—4992一(2012)10—2072—03
胃是食管、贲门癌根治术常用的食管替代物,但全胃代
食管术后有胃潴留、胃扩张而影响心肺功能和生活质量等缺
点 ,管状胃因其更接近食管的生理形态而在近年受到重
视。本文对比观察了管状胃的临床效果,探}寸其临床应用价值。
1资料与方法
1.1临床资料 选2007年5月一2010年12月本院胸外科经病理诊断
为食管癌、贲门癌患者214例,按术中是否将胃做成管状分
为管状胃组和对照组。 1.1.1管状胃组 共118例,男99例(83.9%),女19例
(16.1%);年龄58.81±8.39岁(38—80岁)。病理食管癌
104例(88.1%),贲门癌14例(11.9%);其中胸上段食管癌
9例(7.6%),胸中段食管癌56例(47.5%),胸下段食管癌
39例(33.1%)。 1.1.2对照组共96例,男74例(77.1%),女 例(22.9%);
年龄58.54±9.05岁(27—80岁)。病理食管癌89例
(92.7%),贲门癌7例(7.3%);食管癌中无胸上段癌,胸中
段癌54例(56.3%),胸下段35例(36.5%)(表1)。
1.2手术方法 根据病变位置经右胸、左颈、上腹三切口行根治手术;双
腔气管插管,先游离病变食管和贲门,然后在腹腔游离胃,结
扎切断胃短血管、胃网膜左血管和胃右血管,胃左动脉双重
结扎后切断。保留胃网膜右血管弓。胃充分游离后,以3枚
75mm直线切割吻合器切除部分胃底、贲门和小弯侧胃壁组
织,制作管状胃,以6×15尼龙线连续浆肌层包埋胃壁切缘,
将管状胃的近端与近段食管行胸内吻合或颈部吻合。吻合
结束后常规放置胃肠减压和鼻肠营养管。对照组不把胃作
成管状,其他相同。 管状胃组于左颈部吻合49例(41.5%),主动脉弓上吻 合32例(27.1%),弓下吻合23例(19.5%),贲门癌根治14
例(11.9%)。对照组左颈部吻合8例(8.3%),主动脉弓上
吻合56例(58.3%),弓下吻合25例(26.0%),贲门癌根治 7例(7.3%)(表1)。
表1两组患者一般情况比较n Tab.1 Comparison of general conditions between two groups n
1.3统计学方法 采用SPSS 13.0处理数据,计量资料以均数±标准差(
± )表示,组间比较采用独立样本t检验,计数资料比较采
用行X列卡方检验,P<0.05为差异有统计学意义。
2结果 两组患者均顺利完成手术,管状胃组手术时间135—
320rain,术中出血200—1500ml,输血0—1200ml;术中清除淋
巴结0—65(29)枚,其中转移0—14枚;术后住院时间1
2—