带蒂环状胃壁预防胸内食管胃吻合口并发症临床的研究.docVIP

带蒂环状胃壁预防胸内食管胃吻合口并发症临床的研究 　　[摘要] 目的 探讨“带蒂环状胃壁”预防胸内食管胃吻合口瘘、狭窄、反流的临床效果。方法 随机将665例食管、贲门癌患者分为两组。观察组340例：食管、胃吻合口用带蒂胃壁包被；对照组325例：食管、胃吻合口用大网膜、肺下韧带或纵隔胸膜缝合加固。 结果 观察组、对照组食管胃吻合口瘘发生率分别为0.6%、4.6%；食管胃吻合口狭窄发生率为1.2%、4.8%；术后食管反流率分别为4.4%、52.3%；肺部感染发生率为2.9%、8.9%。结论 “带蒂环状胃壁”包被食管胃吻合口，明显降低了吻合口瘘、狭窄、反流、肺部感染并发症发生率，与传统预防法比较，其预防效果显著。 　　[关键词] 食管癌、贲门癌/外科学；“带蒂环状胃壁”；预防；术后并发症 　　[中图分类号] R655.4 [文献标识码] B [文章编号] 1673-9701（2014）31-0147-04 　　Clinical study of “pedunculated annular gastric wall” in preventing complications of intrathoracic esophagogastric anastomosis 　　CHEN Qiande1 HAN Fei1 CHEN Hanqing2 　　1.Surgical Department， Laiwu Hospital of Traditional Chinese Medicine in Shandong Province， Laiwu 271100，China； 2.Department of obstertrics and Gynecology， Laiwu Hospital of Traditional Chinese Medicine in Shandong Province，Laiwu 271100，China 　　[Abstract] Objective To investigate the clinical effects of “pedunculated annular gastric wall” in the prevention of intrathoracic esophagogastric anastomotic fistula， stenosis and reflux. Methods A total of 665 patients with esophageal and cardiac cancer were randomly divided into two groups. The observation group， consisting of 340 patients， used the pedunculated gastric wall to envelop the esophagogastric anastomotic stoma. The control group， consisting of 325 patients， used the omentum majus， inferior pulmonary ligament or mediastinal pleura to suture and reinforece the esophagogastric anastomotic stoma. Results In the observation group and the control group， the incidences of esophagogastric anastomotic fistula were 0.6% and 4.6% respectively， the incidences of esophagogastric anastomotic stenosis were 1.2% and 4.8% respectively， the incidences of postoperative esophageal reflux were 4.4% and 52.3% respectively， and the incidences of pulmonary infection were 2.9% and 8.9% respectively. Conclusion The application of “pedunculated annular gastric wall” in enveloping esophagogastric anastomotic stoma reduces the incidences of esophagogastric anastomoti