本文選題：食管癌術(shù)后 + 吻合口狹窄�。� 參考：《新鄉(xiāng)醫(yī)學(xué)院》2017年碩士論文

【摘要】：背景消化道重建是食管癌外科治療的重要組成部分,手工吻合胸腔內(nèi)操作程序復(fù)雜,間斷縫合組織損傷大,手術(shù)時(shí)間長(zhǎng),實(shí)際吻合操作與手術(shù)醫(yī)師熟練程度密切相關(guān),術(shù)后吻合口狹窄、吻合口瘺、消化道出血、吻合口炎發(fā)生率較高,增加病人風(fēng)險(xiǎn)。隨著經(jīng)濟(jì)社會(huì)的發(fā)展及人們現(xiàn)代生活理念的建立,器械吻合已成為現(xiàn)今各大醫(yī)院最為普遍的吻合方式,極大減少了吻合口瘺的發(fā)生率,而吻合口狹窄越來越成為食管癌術(shù)后胸外科醫(yī)師關(guān)注的重要課題,文獻(xiàn)報(bào)道其發(fā)生率為1.8-40.0%,患者吞咽困難,進(jìn)食受限癥狀多與術(shù)前相仿,降低患者抗病信心,重度狹窄者甚至需反復(fù)行胃鏡下擴(kuò)張,增加患者的心理及經(jīng)濟(jì)負(fù)擔(dān),降低患者生活質(zhì)量。目的探討改進(jìn)吻合方式以減少吻合口狹窄的方法,為降低食管癌術(shù)后吻合口狹窄發(fā)生率提供幫助。方法收集2013年4月到2015年8月在我院接受左開胸食管癌根治術(shù)的食管癌患者374例,均在本院行食管癌根治術(shù)治療。將374例患者分為兩組,其中常規(guī)吻合組:器械吻合時(shí)不給予胃壁荷包縫合187例;雙荷包吻合組:器械吻合時(shí)分別在食管、胃壁行雙荷包吻合187例,對(duì)比觀察兩組術(shù)后吻合口狹窄發(fā)生情況。結(jié)果通過統(tǒng)計(jì)分析對(duì)比,術(shù)后雙荷包吻合組發(fā)生輕度狹窄17例,常規(guī)吻合組7例(χ2=4.452,P=0.035),中度狹窄12例比4例(χ2=3.199,P=0.074),重度狹窄9例比3例(χ2=2.152,P=0.142),總狹窄例數(shù)38例比14例(χ2=12.866,P=0.000),兩組比較差異有統(tǒng)計(jì)學(xué)意義,雙荷包吻合組相對(duì)優(yōu)于常規(guī)吻合組。結(jié)論雙荷包吻合法能夠更有效減少術(shù)后吻合口狹窄的發(fā)生率。
[Abstract]:Background the reconstruction of digestive tract is an important part of the surgical treatment of esophageal carcinoma. The procedure of manual anastomosis in thoracic cavity is complicated, the tissue injury of discontinuous suture is large, the operation time is long, and the actual anastomosis operation is closely related to the skill of the surgeon. The incidence of anastomotic stenosis, anastomotic leakage, gastrointestinal hemorrhage and anastomotic inflammation was higher, which increased the risk of the patients. With the development of economy and society and the establishment of people's modern concept of life, the anastomosis of instruments has become the most common anastomosis in major hospitals, which greatly reduces the incidence of anastomotic fistula. However, anastomotic stenosis has become an important issue for thoracic surgeons after esophageal cancer surgery. The incidence rate of anastomotic stenosis is 1.8-40.0. the patients with dysphagia and eating restriction symptoms are similar to those before surgery, which reduces the patients' confidence in disease resistance. Patients with severe stenosis even need repeated gastroscopic dilatation to increase the psychological and economic burden of patients and reduce the quality of life of patients. Objective to explore the method of improving anastomosis to reduce anastomotic stenosis, and to provide help to reduce the incidence of anastomotic stenosis after esophageal cancer operation. Methods from April 2013 to August 2015, 374 patients with esophageal cancer underwent radical resection of esophageal cancer in our hospital from April 2013 to August 2015. 374 patients were divided into two groups, the routine anastomosis group (n = 187), the double pocket anastomosis group (n = 187), the esophagus anastomosis group (n = 187) and the stomach wall anastomosis group (n = 187). The incidence of anastomotic stenosis in two groups was observed. Results through statistical analysis and comparison, 17 cases of mild stenosis occurred in the group of double pocket anastomosis. There were 7 cases in routine anastomosis group (蠂 2 + 4.452), 12 cases in moderate stenosis compared with 4 cases (蠂 2 / 3.199P < 0.074), 9 cases in severe stenosis than 3 cases (蠂 2 / 2.152 P < 0. 142), and 38 cases in total stenosis compared with 14 cases (蠂 2 12. 86 6 P 0. 000). There was significant difference between the two groups and the double bag anastomosis group was better than that of routine anastomosis group. Conclusion double-pocket anastomosis can reduce the incidence of anastomotic stenosis more effectively.
【學(xué)位授予單位】：新鄉(xiāng)醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R735.1

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本文編號(hào)：1953944