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目的探讨不同手术方式对贲门癌术后吻合口的影响。方法对7年间收治的156例贲门周围癌患者,按所使用吻合器口径、手术和重建方式分组进行对比分析。结果采用胸腹联合切口57例,经上腹正中切口68例,左侧直接进胸31例。胸腹联合切口组发生吻合口并发症4例(7.0%),经腹切口组发生吻合口并发症5例(7.4%),左侧进胸切口组发生吻合口并发症4例(12.9%)(P>0.05)。此外食管胃吻合口并发症发生率为8.7%,食管空肠吻合口并发症发生率为8.0%(P>0.05)。56例使用28 mm吻合器共发生9例吻合口并发症,发生率为16.1%;95例使用25 mm吻合器共发生4例吻合口并发症,发生率为4.2%(P=0.0102)。结论在经济条件许可的情况下,尽量选择吻合器吻合可以降低手术后吻合口并发症的发生。选择正确的手术方式及使用25 mm口径吻合器的处理方法,可以降低此类患者吻合口并发症的发生率。
Objective To investigate the effect of different surgical methods on postoperative anastomotic of cardia cancer. Methods A total of 156 patients with cardiac cancer who had been treated in 7 years were divided into groups according to caliber of the stapler used, operation and reconstruction. The results of the thoracoabdominal incision in 57 cases, the middle of the incision in 68 cases, 31 cases directly into the left side of the chest. There were 4 cases (7.0%) of anastomotic complications in thoracoabdominal incision group, 5 cases (7.4%) of anastomotic complications in abdominal incision group, and 4 cases (12.9%) of anastomotic complications in left thoracotomy group. (P> 0.05). In addition, the incidence of esophageal-gastric anastomotic complications was 8.7% and the incidence of esophageal-jejunostomy complications was 8.0% (P> 0.05). There were 9 cases of anastomotic complications occurred in 56 cases using 28 mm stapler, the incidence rate was 16.1%. There were 4 cases of anastomotic complications occurred in 95 cases with 25 mm staplers, the incidence was 4.2% (P = 0.0102). Conclusion In the economic conditions permit, try to choose anastomosis anastomosis can reduce postoperative complications of anastomosis. Choosing the right surgical procedure and using a 25 mm caliber stapler can reduce the incidence of anastomotic complications in such patients.