颈部分层吻合重建消化道在食管癌手术中的应用

Application of Cervical Layered Manual Anastomosis for Reconstructing the Upper Alimentary Tract in Esophageal Carcinoma

摘要: 目的：探讨左进胸食管癌根治术中保持弓上胸膜完整的左颈部管状胃食管分层手工吻合重建上消化道的价值。方法：纳入我院胸外科2010年1月至2016年5月收治的食管癌根治术患者206例，根据重建消化道术式不同分为两组：左胸、左颈二切口食管癌根治术(二切口组) 122例，采用保持主动脉弓上胸膜完整的管状胃成形后经食管床上提至左颈部分层吻合重建消化道；右胸、上腹、左颈三切口食管癌根治术(三切口组) 84例，采用右胸径路游离食管，上腹正中切口游离胃，制作成管形胃后上提至左颈部与近端食管行圆形器械吻合。结果：二切口组总手术时间、吻合时间、吻合口狭窄及反流性食管炎的发生率低于三切口组，两组比较差异有统计学意义(P < 0.05)，而围手术期死亡、颈部吻合口瘘及平均住院时间、呼吸功能障碍并发症两组比较差异无统计学意义(P > 0.05)。结论：保持弓上胸膜完整的左颈部管状胃食管分层吻合食管癌根治可在一定程度上缩短手术时间，减轻手术创伤，较为符合生理功能，并能有效降低术后并发症的发生，作为食管胃颈部吻合的一种可选术式值得临床推广应用。

Abstract: Objective: To explore the clinical value of remaining integrated mediastinal pleura upon the aortic arch with tubular stomach and left cervical esophagus layered manual anastomosis for recon-struction alimentary tract in esophagectomy. Methods: 206 patients with esophageal carcinoma from January 2010 to May 2016 in our hospital were selected and divided into the two incisions group (n = 122) and three incisions group (n = 84) according to the operation methods; the study group received two incisions esophagectomy via left thoracic-cervical pathway and using tubular stomach positioned in the original esophageal bed and cervical esophagus layered anastomosis in mucosa (4-0 absorable sutures) and muscular layer (4-0 silk), while the three incisions group underwent conventional neck-chest-abdomen three incisions method and using tubular stomach and cervical esophagus circular stapler anastomosis. All patients underwent transthoracic eso- phagectomy using tubular stomach as esophageal substitute; the tubular stomach was pulled to left cervical region for esophagogastric anastomosis for reconstruction alimentary transit after subtotal esophagectomy. Results: There existed an obvious difference in the occurrence of ana- stomotic strenosis, reflux esophagitis and operative time, the time for anastomosis between the 2 group (P < 0.05) while no statistically difference in the time of postoperative hospital stay, the respiratory dysfunction after the operation, the perioperative death and the occurrence of postoperative anastomotic leakage between the 2 groups (P > 0.05). Conclusion: The remaining integrated mediastinal pleura upon the aortic arch and performing left cervical esophagus layered manual anastomosis in esophageal carcinoma is time-saving, decreases the surgical trauma, fits for physiological function and can effectively reduce the incidence of postoperative complications, so it could be used as an alternative strategy for esophageal cancer and may be used in clinical practice.