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目的观察食管癌三切口手术中,管状胃经食管床和胸骨后两种径路上提行胃食管颈部吻合的临床疗效。方法对揭阳市人民医院2006年6月-2011年6月间98例行食管癌三切口手术患者,随机分为A组(管状胃经食管床)和B组(管状胃经胸骨后)行管状胃上提完成胃食管颈部吻合。结果两组患者手术均顺利完成,无死亡病例,两组病例在手术时间,术中出血量,住院时间方面差异均无统计学意义(P>0.05)。而在吻合口瘘,肺部感染,肺不张,胸腔引流量方面上有明显差异,胸骨后径路组的吻合口瘘发生率(12.5%)明显高于食管床径路组(6.0%,P<0.01)。结论经胸骨后和经食管床径路管状胃上提均为安全、有效的途径;但胸骨后径路术后吻合口瘘发生率较高,而经食管床径路术后肺部感染,肺不张发生率较高,胸腔引流量较多。临床实际应用过程中应根据患者具体情况个体化选择管状胃的上提径路。
Objective To observe the clinical efficacy of gastric esophageal and cervical anastomosis in three surgical approaches of esophageal cancer, tubular gastric esophageal bed and sternum. Methods A total of 98 patients undergoing esophagectomy for three incisions from June 2006 to June 2011 in Jieyang People’s Hospital were randomly divided into group A (tubular stomach and esophageal bed) and group B (tubular stomach and sternum) Stomach to complete the gastroesophageal neck anastomosis. Results The operation of both groups was successfully completed without any deaths. There was no significant difference in the operation time, intraoperative blood loss and hospital stay between the two groups (P> 0.05). There were significant differences in anastomotic fistula, pulmonary infection, atelectasis and thoracic drainage. The incidence of anastomotic fistula (12.5%) in the sternotomy group was significantly higher than that in the esophageal bed (6.0%, P < 0.01). Conclusions The transmucosal and transesophageal approach is a safe and effective way for the supratentorial esophagectomy. However, the incidence of anastomotic fistula after the operation of the sternotomy is high. However, pulmonary infection and atelectasis occur after trans-esophageal approach Higher rates of chest drainage more. Clinical practice should be based on the specific circumstances of individual patients choose to go up the tube path of the stomach.