Zhou Lin, Ge Peng, Chen Jiakuan, Wang Jian, Wang Ming, Li Xiaofei, Jiang Tao
Department of Thoracic Surgery, Tangdu Hospital, The Fourth Military Medical University, Xi'an 710038, China.
Zhonghua Wei Chang Wai Ke Za Zhi. 2016 Sep 25;19(9):1021-1024.
To explore the clinical efficacy and safety of gastroepiploic tunnel esophagogastrostomy applied in minimally invasive esophagectomy and gastroesophageal cervical anastomosis.
Clinical data of 137 esophageal cancer patients who received minimally invasive esophagectomy from December 2013 to June 2015 in Department of Thoracic Surgery, Tangdu Hospital, The Fourth Military Medical University were analyzed retrospectively, including 84 patients receiving anastomosis with tubular anastomat (circular staple group), and 53 patients receiving gastroepiploic tunnel anastomosis(tunnel group, position of tunnel anastomosis located in the side of gastrocolic omentum, about 2-3 cm apart from fundus). Incidence of postoperative anastomotic leakage and stricture was compared between two groups.
All the 137 patients completed minimally invasive esophageal surgeries successfully without conversion to open thoracic or abdominal operation. The time for anastomosis was(20.2±3.1) minutes in circular stapler group and (38.9±2.9) minutes in tunnel group respectively, and the difference was statistically significant (t=75.22, P=0.000 0). The incidence of postoperative anastomotic leakage was 21.4%(18/84) in circular stapler group and 0(0/53) in tunnel group respectively, and the difference was statistically significant (P=0.000 3). All the patients were followed up for more than 6 months. During follow-up period, the incidence of postoperative anastomotic stricture was 14.3%(12/84) in circular stapler group and 3.8%(2/53) in tunnel group respectively, and the difference was statistically significant(P=0.047 9).
The gastroepiploic cervical tunnel anastomosis is safe and effective and can reduce the incidence of postoperative anastomotic leakage as well as anastomotic stricture.
探讨胃网膜隧道式食管胃吻合术在微创食管癌切除及食管胃颈部吻合术中的临床疗效及安全性。
回顾性分析2013年12月至2015年6月第四军医大学唐都医院胸外科137例行微创食管癌切除术患者的临床资料，其中84例行管状吻合器吻合（圆形吻合器组），53例行胃网膜隧道吻合术（隧道组，隧道吻合位置位于胃结肠网膜侧，距胃底约2 - 3 cm）。比较两组术后吻合口漏及狭窄的发生率。
137例患者均成功完成微创食管手术，未中转开胸或开腹手术。圆形吻合器组吻合时间为（20.2±3.1）分钟，隧道组为（38.9±2.9）分钟，差异有统计学意义（t = 75.22，P = 0.000 0）。圆形吻合器组术后吻合口漏发生率为21.4%（18/84），隧道组为0（0/53），差异有统计学意义（P = 0.000 3）。所有患者均随访6个月以上。随访期间，圆形吻合器组术后吻合口狭窄发生率为14.3%（12/84），隧道组为3.8%（2/53），差异有统计学意义（P = 0.047 9）。
胃网膜颈部隧道吻合术安全有效，可降低术后吻合口漏及吻合口狭窄的发生率。
