發(fā)布時(shí)間：2018-05-27 22:20

  本文選題：食管癌 + 側(cè)側(cè)頓合��； 參考：《福建中醫(yī)藥大學(xué)》2016年碩士論文

【摘要】：【目的】比較食管胃頸部改良全機(jī)械側(cè)側(cè)吻合和圓形吻合器吻合對(duì)食管癌術(shù)后吻合口瘺、良性吻合口狹窄、反流性食管炎等主要并發(fā)癥的影響�！痉椒ā坎捎秒S機(jī)對(duì)照研究方法,按入院順序,將2014年1月至2015年6月期間共109例可行手術(shù)治療的胸中、下段食管癌患者隨機(jī)分為食管胃頸部改良全機(jī)械側(cè)側(cè)吻合組（SSSA組)和食管胃頸部圓形吻合器吻合組(CSA組)。分別觀察對(duì)比兩組患者術(shù)中吻合時(shí)間、住院期間死亡率及術(shù)后并發(fā)癥的差異,主要是吻合口瘺、良性吻合口狹窄及反流性食管炎的發(fā)生情況。【結(jié)果】?jī)山M患者的一般臨床資料差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。兩組患者在病理分期、腫瘤位置、術(shù)前輔助放化療情況、術(shù)前基礎(chǔ)疾病情況及手術(shù)方式(開放McKeowi食管癌根治術(shù)或微創(chuàng)McKeown食管癌根治術(shù))上之間差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。兩組患者術(shù)中均達(dá)到R0切除,術(shù)后病理證實(shí)上下切端均為陰性。術(shù)中吻合時(shí)間、住院期間死亡率、肺部并發(fā)癥、心血管并發(fā)癥等方面差異均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。SSSA組與CSA組術(shù)后吻合口瘺發(fā)生率分別為:3.9%(2/51)和8.6%(5/58)(P=0.544)。根據(jù)Visick評(píng)分,SSSA組反流性食管炎的發(fā)生率為34.7%(17/49),與CSA組47.3%(26/55)相比較低,但差異無(wú)統(tǒng)計(jì)學(xué)意義(P=0.210)。術(shù)后1周、1月、3月改良全機(jī)械側(cè)側(cè)吻合口面積分別為2.31(1.58,3.54)cm2、2.16(1.43,3.38)cm~2、2.06(0.29,2.60)cm2,與圓形吻合器組同期相比較大,差異均有統(tǒng)計(jì)學(xué)意義。SSSA組與CSA組術(shù)后吻合口狹窄發(fā)生率分別為2.1%(1/47)和18.5%(10/54),差異有統(tǒng)計(jì)學(xué)意義(P=0.010)�！窘Y(jié)論】食管胃頸部改良全機(jī)械側(cè)側(cè)吻合術(shù)是一種安全、有效、可行的吻合方式,可以減少術(shù)后吻合口良性狹窄的發(fā)生。
[Abstract]:[objective] to compare the effect of modified total mechanical lateral anastomosis and circular stapler anastomosis on anastomotic leakage and stenosis of benign anastomosis in patients with esophageal carcinoma after operation. Effects of major complications such as reflux esophagitis. [methods] A randomized controlled study was conducted in 109 patients with operable esophagitis from January 2014 to June 2015. Patients with lower esophageal carcinoma were randomly divided into two groups: modified total mechanical lateral anastomosis (SSSA group) and circular anastomosis group (CSA group). The difference of anastomosis time, mortality during hospitalization and postoperative complications between the two groups were observed and compared respectively, mainly anastomotic leakage. The incidence of benign anastomotic stenosis and reflux esophagitis. [results] there was no significant difference in general clinical data between the two groups (P 0.05). There was no significant difference between the two groups in pathological staging, tumor location, preoperative adjuvant radiotherapy and chemotherapy, preoperative underlying diseases and surgical methods (open radical resection of McKeowi esophageal carcinoma or minimally invasive McKeown radical resection of esophageal carcinoma). All the patients in both groups achieved R 0 resection during operation, and the upper and lower incisors were negative by pathology after operation. There was no significant difference in anastomotic time, mortality during hospitalization, pulmonary complications and cardiovascular complications between the SSSA group and the CSA group. The incidence of anastomotic fistula in the SSSA group and the CSA group was 2 / 51 and 8. 6% / 58 respectively. According to the Visick score, the incidence of reflux esophagitis in the SSSA group was 34.7 / 49, which was lower than that in the CSA group (47.3 / 26 / 55), but there was no significant difference between the two groups. At 1 week, 1 month and 3 months after operation, the area of modified total mechanical side anastomosis was 2.31 ~ 1.58 ~ 3.54 ~ (cm ~ (2) ~ 2.16 ~ 1.43 ~ 3.38 ~ 3.38 ~ (cm ~ (-1) ~ 0.29 ~ 2.60 cm ~ (2), respectively, which was larger than that of round stapler group in the same period. The incidence of anastomotic stenosis in SSSA group and CSA group was 2.1 / 47 and 18.510 / 54, respectively, and the difference was statistically significant. [conclusion] modified total mechanical lateral anastomosis of esophagus and stomach is a safe, effective and feasible anastomosis. It can reduce the occurrence of benign stenosis of anastomosis after operation.
【學(xué)位授予單位】：福建中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R735.1

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