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目的比较食管和胃壁局部涂抹蛋白生胶和吻合口外局部减压的手工吻合方式与常规手工吻合方式。方法同期进行食管癌手术食管胃颈部吻合230例患者,随机分为研究组(130例)和对照组(100例)。入组患者均行食管胃部分切除食管胃颈部手工吻合术,研究组采用常规食管胃颈部全层吻合方式,吻合食管后壁和前壁时都涂抹生物蛋白胶,颈部手术区域行负压吸引。对照组采用常规手术吻合方式。观察两组患者术后食管胃颈部吻合口瘘的发生、发生后愈合时间、周围组织炎症程度、局部引流量、术后发生胸腔感染导致呼吸衰竭以及术后吻合口狭窄的情况。结果研究组总引流量、瘘愈合时间少于对照组,差异有统计学意义(P<0.05);研究组脓胸并呼吸障碍发生例数少于对照组,差异有统计学意义(P=0.017<0.05);研究组吻合口瘘发生例数低于对照组,差异有统计学意义(P=0.003<0.05);研究组吻合口狭窄与对照组比较,差异无统计学意义(P=0.707>0.05);研究组周围组织炎症反应较对照组轻。结论吻合口食管和胃壁局部涂抹生物蛋白胶以及吻合口外局部减压在食管癌食管胃部分切除食管胃颈部手工吻合时能明显减少吻合口瘘的发生,临床可推广应用。
Objective To compare the methods of manual anastomosis of partial decompression of esophageal and gastric wall by local application of protein gelatin and anastomotic with conventional manual anastomosis. Methods 230 patients with esophageal and gastric anastomosis during esophagectomy were randomly divided into study group (130 cases) and control group (100 cases). All patients underwent esophagogastric partial resection of esophagogastric neck anastomosis, the study group using conventional esophageal and gastric full-thickness anastomosis, anastomosis esophageal wall and anterior wall smear biological protein glue, neck surgery area negative Pressure to attract. Control group using conventional surgical anastomosis. The incidence of postoperative esophageal-gastric anastomotic fistula, healing time after occurrence, degree of inflammation in surrounding tissue, local drainage volume, postoperative thoracic infection leading to respiratory failure and postoperative anastomotic stenosis were observed. Results The total drainage and fistula healing time in the study group were less than those in the control group (P <0.05). The incidence of empyema and respiratory disorders in the study group was less than that in the control group (P = 0.017 <0.05). The incidence of anastomotic fistula in the study group was lower than that in the control group (P = 0.003 <0.05). There was no significant difference in the anastomotic stricture between the study group and the control group (P = 0.707> 0.05). The inflammatory reaction around the study group was lighter than that of the control group. Conclusion Anastomotic esophageal and gastric wall topical application of bioprotein glue and local anastomotic decompression can significantly reduce the incidence of anastomotic fistula when esophagogastric esophagogastric resection of the esophagogastric stomach and neck are feasible.