CAJ | 학술논문

目的：评估全腔镜食管癌三野根治术食管胃颈部吻合方式（机械或手工）对术后吻合口相关并发症发生的影响。方法回顾性分析2010年1月至2013年11月间在福建省肿瘤医院胸外科接受全腔镜食管癌三野根治术治疗的203例食管癌患者的临床资料。根据颈部吻合方式的不同，分为机械吻合组（104例）和手工吻合组（99例）。比较两组患者术后吻合口相关并发症发生率。结果机械吻合组术中吻合时间较手工吻合组明显缩短[（15．5±5．0） min比（28．0±4．5） min，P＜0．01]。两组术后吻合口瘘发生率分别为5．8％（6/104）和3．0％（3/99），差异无统计学意义（P＞0．05）；吻合口狭窄发生率分别为9．6％（10/104）和2．0％（2/99），差异有统计学意义（P＜0．05）。结论与手工吻合相比，全腔镜食管癌三野根治术食管胃颈部机械吻合操作简单、吻合确切，但吻合口狭窄的风险增加，因此，在临床实践中，应结合患者的具体情况合理选择吻合方式。
목적：평고전강경식관암삼야근치술식관위경부문합방식（궤계혹수공）대술후문합구상관병발증발생적영향。방법회고성분석2010년1월지2013년11월간재복건성종류의원흉외과접수전강경식관암삼야근치술치료적203례식관암환자적림상자료。근거경부문합방식적불동，분위궤계문합조（104례）화수공문합조（99례）。비교량조환자술후문합구상관병발증발생솔。결과궤계문합조술중문합시간교수공문합조명현축단[（15．5±5．0） min비（28．0±4．5） min，P＜0．01]。량조술후문합구루발생솔분별위5．8％（6/104）화3．0％（3/99），차이무통계학의의（P＞0．05）；문합구협착발생솔분별위9．6％（10/104）화2．0％（2/99），차이유통계학의의（P＜0．05）。결론여수공문합상비，전강경식관암삼야근치술식관위경부궤계문합조작간단、문합학절，단문합구협착적풍험증가，인차，재림상실천중，응결합환자적구체정황합리선택문합방식。
Objective To compare the associated anastomotic complication of cervical esophagogastric anastomosis between stapled and hand-sewn anastomosis in minimally invasive esophagectomy (MIE). Methods Clinical data of 203 patients with esophageal cancer receiving combined thoracoscopic and laparoscopic esophagectomy with anastomosis in the neck in our hospital from January 2010 to November 2013 were retrospectively analyzed. All the patients were divided into stapled group (104 patients) and hand-sewn group (99 patients). The incidence of anastomotic leakage and anastomotic stricture between these two groups were compared. Results There were no significant differences between two groups in gender, age, body mass index, total protein, albumin, and neoadjuvant chemotherapy (all P>0.05). There was no significant difference between the two groups in the incidence of anastomotic leakage[6/104(5.77%) vs. 3/99(3.03%), P>0.05], while the difference in the incidence of anastomotic stricture was significant [10/104(9.62%) vs. 2/99(2.02%), P<0.05]. The time of anastomosis, dieting and hospital stay was (15.5±5.0) min, (5.0±2.8) d and (18.3±5.9) d in stapled group, which was significantly shorter than (28.0±4.5) min, (5.9±1.2) d and (21.8±4.2) d in hand-sewn group (all P<0.05). Conclusion In the minimally invasive esophagectomy, stapled cervical esophagogastric anastomosis is simple and precise , but it is associated with increased risk of anastomotic stricture, therefore the type of anastomosis should be chosen based on the conditions of the patient.