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目的:探讨食管、贲门癌切除胃食管吻合,吻合口浆肌层内翻缝合包埋处理的必要性.方法:选取2012-03/2013-08在新疆医科大学第一附属医院胸外科行食管、贲门癌切除、胃食管吻合术并符合条件的患者244例,其中实验组78例实施单纯胃食管吻合,而对照组166例在胃食管吻合基础上行吻合口浆肌层内翻缝合包埋处理.对两组患者的手术效果和术后并发症进行比较分析.结果:术后实验组和对照组的吻合口瘘发生率分别为1.28%(1/78)、5.42%(9/166),差异无统计学意义(P=0.24);吻合口内径分别为13.23 mm±2.93 mm、10.91 mm±2.80 mm,差异有统计学意义(P=0.00);吻合口狭窄发生率分别为5.26%(4/76)和17.42%(27/155)差异有统计学意义(P=0.01);实验组吞咽困难评分低于对照组,差异有统计学意义(P=0.02);实验组和对照组术后返流反酸评分差异无统计学意义(P=0.50).结论:传统的胃食管吻合口浆肌层内翻缝合包埋处理对预防吻合口瘘的发生无实际意义,无法减少术后返流性胃食管吻合口炎的发生,并且增加术后吻合口狭窄的发生率.
Objective: To investigate the necessity of resection of gastroesophageal anastomosis esophageal and gastric cardia carcinoma by anastomosis and suture anastomosis of serous myometrium.Methods: The esophageal and esophageal mucosa of the esophagus and esophagus were resected in the Department of Thoracic Surgery, the First Affiliated Hospital of Xinjiang Medical University from 2012-03 to 2013-08, Gastric esophageal resection and gastroesophageal anastomosis were performed in 244 cases. Among them, 78 cases in the experimental group were treated with simple gastroesophageal anastomosis, while 166 cases in the control group received anastomotic osseous suturing and embedding treatment on the basis of gastroesophageal anastomosis. The operative and postoperative complications of the two groups were compared.Results: The incidence of anastomotic fistula in experimental group and control group were 1.28% (1/78) and 5.42% (9/166) respectively, the difference (P = 0.24). The anastomotic diameter was 13.23 mm ± 2.93 mm and 10.91 mm ± 2.80 mm, respectively, with significant difference (P = 0.00). The anastomotic stenosis rates were 5.26% (4 / 76) and 17.42% (27/155), respectively (P = 0.01). The dysphagia score of the experimental group was lower than that of the control group (P = 0.02) Reflux acid score was no significant difference (P = 0.50) .Conclusion: The traditional gastroesophageal anastomosis plaque varus suture Treatment has no practical significance in preventing the occurrence of anastomotic fistula, and can not reduce the occurrence of reflux gastroesophageal anastomotic stoke after operation, and increases the incidence of postoperative anastomotic stenosis.