Zhou Dong, Liu Quan-Xing, Deng Xu-Feng, Zheng Hong, Lu Xiao, Dai Ji-Gang, Jiang Li
Department of Thoracic Surgery, Xinqiao Hospital, Third Military Medical University, Chongqing, People's Republic of China.
Cancer Manag Res. 2018 Feb 7;10:257-263. doi: 10.2147/CMAR.S145917. eCollection 2018.
Anastomotic leakage is the most feared postoperative complication after esophagectomy. Omentoplasty, wrapping the omentum around the alimentary tract anastomosis, is thought to decrease the anastomotic leakage rate. The purpose of this clinical study is to investigate the use of omentoplasty to reinforce cervical esophagogastrostomy after minimally invasive esophagectomy (MIE).
In this retrospective study, the data of 160 consecutive patients who underwent cervical esophagogastrostomy after MIE between September 2012 and May 2015 were analyzed, 87 who underwent omentoplasty (group A) and 73 who did not undergo omentoplasty (group B). The primary outcome was the incidence of anastomotic leakage and anastomotic strictures after the operation. Secondary outcomes were other complications and mortality rate. Univariate and multivariate analysis of variables associated with an increased risk for anastomotic leak was performed.
The median age was 61 years (range, 37-82 years). The anastomotic leakage rates were 4.6% (4/87) in group A and 15.1% (11/73) in group B ( = 0.023). There was no statistical significance in anastomotic stricture rates between group A (6.9%) and group B (9.6%; = 0.535). No difference was noted in other complications between the groups. There was a trend toward lower leak-associated mortality rates for group A (0%) compared with that for group B (4.1%).
Cervical esophagogastrostomy with omentoplasty is more effective than esophagogastrostomy without omentoplasty for the prevention of anastomotic leakage in MIE with cervical anastomosis. Omentoplasty could be used as an adjunct technique to reduce the incidence of anastomotic leakage in cervical esophagogastrostomy following MIE.
吻合口漏是食管切除术后最令人担忧的术后并发症。网膜成形术，即将大网膜包裹在消化道吻合口周围，被认为可降低吻合口漏发生率。本临床研究的目的是探讨网膜成形术在微创食管切除术后（MIE）加强颈部食管胃吻合术中的应用。
在这项回顾性研究中，分析了2012年9月至2015年5月期间连续160例行MIE术后颈部食管胃吻合术患者的数据，其中87例行网膜成形术（A组），73例未行网膜成形术（B组）。主要结局是术后吻合口漏和吻合口狭窄的发生率。次要结局是其他并发症和死亡率。对与吻合口漏风险增加相关的变量进行单因素和多因素分析。
中位年龄为61岁（范围37 - 82岁）。A组吻合口漏发生率为4.6%（4/87），B组为15.1%（11/73）（P = 0.023）。A组（6.9%）和B组（9.6%；P = 0.535）的吻合口狭窄发生率无统计学意义。两组间其他并发症无差异。与B组（4.1%）相比，A组（0%）漏相关死亡率有降低趋势。
在MIE颈部吻合术中，带网膜成形术的颈部食管胃吻合术在预防吻合口漏方面比不带网膜成形术的食管胃吻合术更有效。网膜成形术可作为一种辅助技术，以降低MIE术后颈部食管胃吻合术中吻合口漏的发生率。
