胃食管吻合口预防性大网膜覆盖在三野根治术后的应用
Omentoplasty in preventing anastomotic leakage of oesophagogastrostomy following radical oesophagectomy with three-field lymphadenectomy.
机构信息
Department of Thoracic Surgery, Teaching Hospital of Fujian Medical University, Fujian Provincial Cancer Hospital, Fuzhou, China.
出版信息
Eur J Cardiothorac Surg. 2013 Feb;43(2):274-8. doi: 10.1093/ejcts/ezs285. Epub 2012 May 30.
OBJECTIVES
Anastomotic leakage is a major cause of mortality in oesophageal surgery. Whether omentoplasty after oesophagogastrostomy could reduce anastomotic leakage is still controversial. The aim of this study is to investigate the function of omentoplasty to reinforce cervical oesophagogastrostomy after radical oesophagectomy with three-field lymphadenectomy.
METHODS
A total of 184 patients who underwent radical oesophagectomy with three-field lymphadenectomy took part in this prospective study. Patients were randomized to receive either the omentoplasty or non-omentoplasty. In the omentoplasty group, the omentum was wrapped around the oesophagogastric anastomosis after oesophagogastrostomy. Age, gender, location of carcinoma, stage, body mass index, diabetes, coronary artery disease, peripheral vascular disease and performance of omentoplasty were recorded. The anastomotic leakage and stricture and recurrence site were followed up for three years after the operation.
RESULTS
The two groups were comparable in terms of age, gender, location of carcinoma, stage, body mass index, diabetes, coronary artery disease and peripheral vascular disease (P > 0.05). In contrast to the non-omentoplasty group with a postoperative anastomotic leakage rate of 9.8%, the omentoplasty subjects demonstrated a significantly lower rate of 3.3% (P < 0.05). No lethal leakage was found in the omentoplasty group, while two non-omentoplasty patients developed incurable empyema and mediastinitis due to leakage and ultimately died. The rate of incidence of anastomotic stricture in the omentoplasty and non-omentoplasty groups were 4.3% and 2.2% respectively. Of the five cases of death during the hospital stay, two were found in the omentoplasty group and three in non-omentoplasty. There was no significant difference of lethal leakage, stricture and death rate between the two groups (P > 0.05). The hospital stay was significantly longer for non-omentoplasty patients, compared with that for the omentoplasty subjects (P < 0.05). Tumour recurrence in lymphatic- or haematogenous metastasis was similar in both groups (P > 0.05).
CONCLUSION
Omentoplasty may prevent anastomotic leakage of oesophagogastrostomy following radical oesophagectomy with three-field lymphadenectomy.
目的
吻合口漏是食管手术后死亡的主要原因。胃食管吻合后行网膜成形术是否能减少吻合口漏仍存在争议。本研究旨在探讨网膜成形术在根治性三野淋巴结清扫术后对颈段食管胃吻合口的作用。
方法
本前瞻性研究共纳入 184 例接受根治性三野淋巴结清扫术的患者。患者被随机分为网膜成形术组和非网膜成形术组。在网膜成形术组，胃食管吻合后，用网膜包裹食管胃吻合口。记录年龄、性别、癌灶位置、分期、体重指数、糖尿病、冠心病、外周血管疾病和网膜成形术的实施情况。术后 3 年随访吻合口漏、狭窄和复发部位。
结果
两组在年龄、性别、癌灶位置、分期、体重指数、糖尿病、冠心病和外周血管疾病方面无统计学差异（P > 0.05）。与非网膜成形术组术后吻合口漏发生率 9.8%相比，网膜成形术组明显较低，为 3.3%（P < 0.05）。网膜成形术组无致命性漏液，而非网膜成形术组有 2 例因漏液导致无法治愈的脓胸和纵隔炎而死亡。吻合口狭窄发生率网膜成形术组和非网膜成形术组分别为 4.3%和 2.2%。住院期间死亡的 5 例中，网膜成形术组 2 例，非网膜成形术组 3 例。两组致命性漏液、狭窄和死亡率无统计学差异（P > 0.05）。非网膜成形术组的住院时间明显长于网膜成形术组（P < 0.05）。两组在淋巴或血行转移的肿瘤复发方面无差异（P > 0.05）。
结论
网膜成形术可能预防根治性三野淋巴结清扫术后食管胃吻合口漏。
Zotero 插件