本文關(guān)鍵詞：吻合器吻合與手工舌狀漿肌瓣覆蓋吻合在食管癌頸部吻合術(shù)中的應(yīng)用對比　出處：《新鄉(xiāng)醫(yī)學(xué)院》2015年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 食管癌 吻合器 手工吻合 并發(fā)癥

【摘要】：背景食管癌(Esophageal cancer, EC)是人類常見的惡性腫瘤之一,在發(fā)展中國家表現(xiàn)出高發(fā)病率和高死亡率兩大特征。EC的發(fā)病率呈明顯的地區(qū)性分布差異,我國華北太行山區(qū)的河南省林州和河北省磁縣均屬于食管癌高發(fā)區(qū)。目前,外科手術(shù)仍是EC治療的主要手段。由于EC存在多點起源,癌灶散在、互不連續(xù)的特點,因此,盡量切除較多的食管是手術(shù)治療EC的基本要求之一。由于食管胃頸部吻合術(shù)能切除較多的食管,最大程度降低吻合口的局部復(fù)發(fā)率,因而是治療EC廣泛采用的手術(shù)方式。但是,食管胃頸部吻合術(shù)的并發(fā)癥發(fā)生率高,主要包括吻合口瘺和吻合口狹窄。為減少頸部吻合口瘺等并發(fā)癥的發(fā)生率,不同醫(yī)院采取了多種吻合方法,如隧道式吻合、全層吻合、側(cè)側(cè)吻合、機械吻合等。目前我院食管胃頸部吻合主要有圓形吻合器吻合和手工舌狀漿肌瓣覆蓋食管胃吻合兩種吻合方式。為比較兩種吻合方式的優(yōu)劣,本研究比較了分別接受吻合器吻合(99例)、舌狀漿肌瓣覆蓋食管胃吻合(90例)手術(shù)EC患者的手術(shù)時間、住院時間、手術(shù)住院費用、吻合口瘺例數(shù)及程度、吻合口狹窄例數(shù)及程度、食管反流程度等,為食管癌頸部吻合術(shù)采取何種方式吻合,提供參考依據(jù)。目的探討在食管癌頸部吻合術(shù)中,吻合器吻合與手工舌狀漿肌瓣覆蓋吻合的手術(shù)效果及并發(fā)癥發(fā)生情況,確定個體化食管癌頸部吻合術(shù)判定標準,提高手術(shù)效率,減少并發(fā)癥的發(fā)生。方法選擇189例食管癌手術(shù)患者,經(jīng)左開胸實施雙野淋巴結(jié)清掃及食管管狀胃頸部吻合術(shù),其中吻合器吻合99例,舌狀漿肌瓣覆蓋食管胃吻合90例,兩組患者術(shù)后病理上下切緣均為陰性。比較分析兩種吻合術(shù)式的手術(shù)時間、術(shù)中出血、住院時間、手術(shù)住院費用、吻合口瘺例數(shù)及程度、吻合口狹窄例數(shù)及程度、食管反流程度等參數(shù),確定兩種術(shù)式的利弊。結(jié)果1.吻合器吻合組99例患者4例(4.0%,n=99)發(fā)生吻合口瘺,舌狀漿肌瓣覆蓋吻合組90例患者中11例(12.2%,n=90)發(fā)生吻合口瘺,吻合器組與舌狀漿肌瓣覆蓋組吻合口瘺發(fā)生率的差異有統(tǒng)計學(xué)意義(P0.05,χ2=4.32)。2.吻合器組中7例(7.1%,n=99)發(fā)生吻合口狹窄,舌狀漿肌瓣覆蓋食管胃吻合組中8例(8.9%,n=90)發(fā)生吻合口狹窄。兩組吻合口狹窄發(fā)生率的差異無統(tǒng)計學(xué)意義(P0.05,χ2=0.24)。3.吻合器組中35例(35.4%,n=99)發(fā)生反流性食管炎,舌狀漿肌瓣覆蓋食管胃吻合組中21例(21.1%,n=90)發(fā)生反流性食管炎,兩組發(fā)生反流性食管炎的差異有統(tǒng)計學(xué)意義(P0.05,χ2=4.69)。4.吻合器組平均住院費用(13356.8±60.7元)顯著高于舌狀漿肌瓣覆蓋吻合組平均住院費用(12147.6±62.5元),兩組差異有統(tǒng)計學(xué)意義(P0.01,t=134.86)。5.吻合器組平均住院天數(shù)(19±1.5d)低于舌狀漿肌瓣覆蓋吻合組(21±1.8d),兩組差異有統(tǒng)計學(xué)意義(P0.01,t=8.33)。6.吻合器組平均手術(shù)時間(181.3±5.7min)和舌狀漿肌瓣覆蓋吻合組平均手術(shù)時間(180.6±6.2min)比較無統(tǒng)計學(xué)差異(P0.05,t=0.81)。7.吻合器組平均術(shù)中出血量(239±76m1)和舌狀漿肌瓣覆蓋吻合組平均術(shù)中出血量(242±72m1)比較無統(tǒng)計學(xué)差異(P0.05,t=0.28)。結(jié)論在頸部食管管狀胃的兩種吻合術(shù)式中,圓形吻合器吻合術(shù)操作簡單,初學(xué)者容易掌握,術(shù)后吻合口瘺發(fā)生率低,住院時間短,但其術(shù)后返流發(fā)生率高,增加住院費用；舌狀漿肌瓣覆蓋食管胃吻合術(shù)吻合口瘺發(fā)生率高,住院時間長,但其術(shù)后抗返流效果好,可減少住院費用。兩者手術(shù)時間和出血量無區(qū)別。兩種吻合方式各有利弊,在臨床工作中可根據(jù)患者病情、經(jīng)濟及身體狀況確定最佳手術(shù)方式。
[Abstract]:Background: esophageal cancer (Esophageal cancer EC) is one of the most common malignant tumors, the incidence of high morbidity and mortality rate of.EC was two characteristics of regional distribution differences showed in the developing world, North China's Henan province in Linzhou Taihang Mountain Area in Hebei province and Cixian belong to the high incidence area of esophageal cancer. At present. The main means of surgery is still the treatment of EC. Because the EC has multiple origins, foci scattered in discrete characteristics, therefore, as more resection is one of the basic requirements of esophageal surgery in the treatment of EC. Because of cervical esophagogastrostomy in esophageal resection surgery can be more, to minimize the local recurrence rate of anastomosis thus, operation is widely used in the treatment of EC. However, cervical esophagogastrostomy in the high incidence of complications, including anastomotic leakage and stenosis. To reduce cervical anastomotic fistula and other complications The incidence of different hospitals adopted various methods such as anastomosis, tunnel anastomosis, full-thickness anastomosis anastomosis, mechanical anastomosis in our hospital. The cervical esophagogastrostomy is circular stapling and hand shaped seromuscular flap covering two anastomosis of esophagogastric anastomosis. For comparing the two modes., this study compares the received anastomosis (99 cases), tongue seromuscular flap coverage of esophagogastric anastomosis (90 cases) EC surgical operation time, hospitalization time, hospitalization costs of surgery, anastomotic fistula cases and anastomotic stenosis degree, the number of cases and the degree of esophageal reflux degree, esophageal what way cancer neck anastomosis anastomosis, to provide the reference. Objective to investigate the neck anastomosis in esophageal cancer, surgical effect and complications of stapling anastomosis and manual tongue seromuscular flap covered the incidence of certain individual cervical esophageal carcinoma Criteria of anastomosis, improve operation efficiency, reduce the incidence of complications. Methods 189 patients with carcinoma of esophagus through left thoracotomy of two field lymphadenectomy and esophageal gastric tube neck anastomosis, the anastomosis in 99 cases, ligulate pulp muscle flap of esophagogastric anastomosis in 90 cases, two groups of patients with postoperative pathological conditions the margins were negative. The comparative analysis of two kinds of anastomosis operation time, intraoperative bleeding, hospitalization time, hospitalization costs of surgery, anastomotic fistula cases and anastomotic stenosis degree, the number of cases and the degree of esophageal reflux degree and other parameters to determine the advantages and disadvantages of the two kinds of surgical anastomosis. Results of 1. groups of 99 in 4 patients (4%, n=99) of anastomotic fistula, tongue flap seromuscular anastomosis group 90 patients in 11 cases (12.2%, n=90) of anastomotic fistula, stapler group and tongue seromuscular flap coverage group anastomotic fistula rate difference was statistically significant (P0.05, 蠂2=4.32).2.鍚誨悎鍣ㄧ粍涓，

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