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目的:探讨经裂孔食管切除、食管-胃颈部半机械侧侧吻合术在食管癌外科治疗中的应用价值。方法:>60岁合并低肺功能的食管癌患者114例,观察组41例行经裂孔食管切除、食管-胃颈部半机械侧侧吻合术;对照组73例,行经左胸后外侧切口食管切除、食管-胃颈部手工端侧吻合术。观察患者术前术后肺功能变化,术后并发症等。结果:114例均完整切除,无术中死亡;术后30d内对照组1例死于肺部感染呼吸衰竭。术后吻合口瘘、反流性食管炎、术后肺部并发症的发生率及手术时间、肺功能、动脉血氧分压、术后住院天数等方面,观察组与对照组比较,差异有统计学意义(P<0.05);声带麻痹发生率和淋巴结清扫数目2组比较差异无统计学意义(P>0.05)。观察组的吻合口面积显著大于对照组。结论:经裂孔食管切除、食管-胃颈部半机械吻合术是一种安全快速的手术方式,为高龄低肺功能食管癌患者理想的选择。
Objective: To investigate the value of esophageal resection and esophagogastrostomy in the surgical treatment of esophageal cancer. Methods: 114 patients with esophageal cancer> 60 years old with low pulmonary function were included. 41 cases in the observation group were treated by split esophageal resection and esophagogastrostomy with semi-mechanical side-to-side anastomosis. In the control group, 73 cases were treated by left thoracotomy, Excision, esophageal - stomach neck manual anastomosis. Observed before and after patients with pulmonary function changes, postoperative complications. Results: All 114 cases were completely resected and no intraoperative death occurred. One case died of pulmonary infection and respiratory failure within 30 days after operation. Postoperative anastomotic fistula, reflux esophagitis, the incidence of postoperative pulmonary complications and operation time, pulmonary function, arterial oxygen tension, postoperative hospital days, the observation group compared with the control group, the difference was (P <0.05). There was no significant difference in the incidence of vocal cord paralysis and the number of lymph node dissection between the two groups (P> 0.05). The anastomosis area of the observation group was significantly larger than that of the control group. Conclusion: The posterior esophageal resection and semi-mechanical esophagogastrostomy are a safe and rapid surgical procedure, which is an ideal choice for elderly patients with low-grade pulmonary function esophageal cancer.