食管癌术后吻合口生物力学分析及加强措施

Biomechanical Analysis and Strengthening Measures of Anastomosis of Esophageal Cancer

摘要: 目的：通过体外模拟实验对食管胃吻合口的生物力学进行分析并应用奈维补片加强吻合口局部的抗拉力。方法：选取食管癌术后复查胃镜的患者，通过计算分别得出颈部吻合口和胸部吻合口到食管入口的距离；通过在X线下测量头部活动时梨状窝下极的活动度来估测食管入口的位移；以上述测量结果为依据，应用新鲜猪食管、胃标本进行体外模拟实验，测量不同长度食管在相同位移下所受到的牵拉力，然后应用奈维补片加强食管胃吻合口，并测量吻合口所能承受的最大拉力。结果：1) 食管入口到颈部吻合口、主动脉弓上吻合口的平均距离分别为5.41 cm ± 1.22 cm、7.60 cm ± 1.36 cm；两者比较差异有统计学意义P = 0.000。2) 抬头和低头活动时，梨状窝下极平均活动范围为(2.26 ± 0.58) cm。3) 随着食管长度的增加，食管拉伸2 cm时所承受的拉力逐渐减小。并且食管长度每增加1cm，各组食管所承受的拉力值差异均有统计学意义P < 0.05。4) 常规吻合后吻合口承受最大拉力平均值为(20.00 ± 1.65) N，应用奈维加强后吻合口承受最大拉力平均值为(27.67 ± 0.95) N，两组比较差异有统计学意义(P = 0.001)。结论：颈部活动导致的食管入口位移会造成食管癌术后吻合口张力的增加，可能是导致吻合口瘘的重要因素；应用奈维补片可以增加吻合口的局部抗拉强度。

Abstract: Objective: To analyze the biomechanics of esophagogastric anastomosis by in vitro simulation experiment and to strengthen the local tensile resistance of anastomosis by Neoveil^®. Methods: Patients who underwent gastroscopy after esophageal cancer surgery were selected, and the distances from neck anastomosis and chest anastomosis to esophageal entrance were calculated respectively. Displacement of the esophageal inlet was estimated by X-ray measurement of the motion range of the lower pole of piriform recess during head movement. Based on the above measurement results, fresh pig esophagus and stomach samples were used for in vitro simulation experiment to measure the tensile force of different lengths of esophagus under the same displacement, Then Neoveil^® was used to strengthen the esophagogastric anastomosis and the maximum tensile force of the anastomosis was measured. Results: 1) The average distance from the esophageal entrance to the neck anastomosis and the anastomosis above the aortic arch was 5.41 cm ± 1.22 cm and 7.60 cm ± 1.36 cm, respectively. The difference between the two was statistically significant P = 0.000. 2) The average motion range of the lower pole of piriform recess was (2.26 ± 0.58) cm when the head was raised and lowered. 3) As the length of the esophagus increases, the pulling force on the esophagus when stretched 2 cm decreases gradually. Moreover, for each 1 cm increase in esophageal length, the difference in esophageal tensile force between each group was statistically significant (P < 0.05). 4) After conventional anastomosis, the mean value of the maximum tensile force of the anastomosis was (20.00 ± 1.65) N, and after Neoveil® was used to strengthen the anastomosis, the mean value of the maximum tensile force of the anastomosis was (27.67 ± 0.95) N, the difference between the two groups was statistically significant (P = 0.001). Conclusion: The esophageal entrance displacement caused by neck movement will increase the anastomotic tension after esophageal cancer surgery, which may be an important factor leading to anastomotic fistula. The local tensile strength of anastomosis can be increased by using Neoveil^®.