食管癌手术中管胃重建消化道的临床研究

目的:探讨食管癌手术中管胃重建消化道的临床应用及其术后生活质量。方法:474例食管癌患者随机分成管胃组及对照组,管胃组243例,对照组231例。管胃组采用切除胃小弯侧形成管状胃由食管裂孔经后纵隔沿食管床及主动脉弓后送至右胸膜顶或者左颈部行食管胃吻合,食管胃吻合采用粘膜肌层分层吻合;对照组则采用全胃由同样途径在右胸膜顶或左颈部行食管胃断端分层吻合。结果:两组病人术后均恢复出院,无手术死亡。管胃组吻合瘘发生率为0.8%,明显低于对照组吻合瘘发生率5.1%,p<0.05;吻合口狭窄发生率1.2%,明显低于对照组吻合狭窄发生率13.8%,p<0.05;反流性食管炎发生率为1.2%,明显低于对照组反流性食管炎发生率16.4%,p<0.05。结论:食管癌手术中管胃重建消化道更加符合患者生理解剖要求,其术后并发症发生率明显降低,术后生活质量明显改善。

Clinical Study of Reconstruction of Esophagus with Gastric Tube for Carcinoma of Esophagus

Objective： To evaluate the application and the effect of gastric reconstruction with tubiform stomach during esophagectomy.Methods： 474 cases were divided into gastric tube group and control group.In gastric tube group,after carcinoma was cut,the stomach was made,the tube with lesser curvature gastric minor was cut,the gastric tube was reconstructed in the neck or at the copula of pleura via the esophageal bed through esophageal hiatus;in control group,gastric tube was reconstructed with tradition stomach.Results： All patients were recovered after operation.The incidences of stoma stenosis,thoracgastric syndrome and reflux of tubiform stomach group were decreased than those of control group,p0.05.Conclusion： The gastric tube reconstruction with tubiform stomach accords with physiolgicoanatomical function of the digestive tract.It could reduce the post-operation complications and improve the postoperative quality of life.