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全喉咽食管切除术后手工吻合与机械吻合的比较。

The comparison of manual and mechanical anastomosis after total pharyngolaryngoesophagectomy.

作者信息

Wang Kexi, He Xiaotian, Wu Duoguang, Wang Kefeng, Li Yuquan, Wang Wenjian, Hu Xueting, Lei Kai, Tan Binghua, Liang Ruihao, Cai Qian, Wang Minghui

机构信息

Department of Thoracic Surgery, Sun Yat-sen Memorial Hospital, Guangzhou, China.

Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.

出版信息

Front Oncol. 2023 Feb 27;13:1041396. doi: 10.3389/fonc.2023.1041396. eCollection 2023.

DOI:10.3389/fonc.2023.1041396
PMID:36923420
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10010104/
Abstract

BACKGROUND

Total pharyngolaryngoesophagectomy (TPLE) is considered as a curative treatment for hypopharynx cancer and cervical esophageal carcinomas (HPCECs). Traditional pharyngo-gastric anastomosis is usually performed manually, and postoperative complications are common. The aim of this study was to introduce a new technique for mechanical anastomosis and to evaluate perioperative outcomes and prognosis.

METHODS

From May 1995 to Nov 2021, a series of 75 consecutive patients who received TPLE for a pathological diagnosis of HPCECs at Sun Yat-sen Memorial Hospital were evaluated. Mechanical anastomosis was performed in 28 cases and manual anastomosis was performed in 47 cases. The data from these patients were retrospectively analyzed.

RESULTS

The mean age was 57.6 years, and 20% of the patients were female. The rate of anastomotic fistula and wound infection in the mechanical group were significantly lower than that in the manual group. The operation time, intraoperative blood loss and postoperative hospital stays were significantly higher in the manual group than that in the mechanical group. The R0 resection rate and the tumor characteristics were not significantly different between groups. There was no significant difference in overall survival and disease-free survival between the two groups.

CONCLUSION

The mechanical anastomosis technology adopted by this study was shown to be a safer and more effective procedure with similar survival comparable to that of manual anastomosis for the HPCECs patients.

摘要

背景

全喉咽食管切除术（TPLE）被认为是下咽癌和颈段食管癌（HPCECs）的一种根治性治疗方法。传统的咽胃吻合术通常采用手工操作，术后并发症很常见。本研究的目的是引入一种机械吻合新技术，并评估围手术期结果和预后。

方法

对1995年5月至2021年11月在中山大学附属孙逸仙纪念医院接受TPLE且病理诊断为HPCECs的75例连续患者进行评估。其中28例行机械吻合，47例行手工吻合。对这些患者的数据进行回顾性分析。

结果

患者平均年龄57.6岁，20%为女性。机械吻合组的吻合口瘘和伤口感染发生率显著低于手工吻合组。手工吻合组的手术时间、术中出血量和术后住院时间显著高于机械吻合组。两组的R0切除率和肿瘤特征无显著差异。两组的总生存率和无病生存率无显著差异。

结论

本研究采用的机械吻合技术对HPCECs患者来说是一种更安全、有效的手术方法，其生存率与手工吻合相似。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6eb6/10010104/1da0c8d6e674/fonc-13-1041396-g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6eb6/10010104/ded01b47a82a/fonc-13-1041396-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6eb6/10010104/0416d2582855/fonc-13-1041396-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6eb6/10010104/3f11c8c21792/fonc-13-1041396-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6eb6/10010104/7e2f1595e411/fonc-13-1041396-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6eb6/10010104/37ae77d1d0b5/fonc-13-1041396-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6eb6/10010104/1da0c8d6e674/fonc-13-1041396-g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6eb6/10010104/ded01b47a82a/fonc-13-1041396-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6eb6/10010104/0416d2582855/fonc-13-1041396-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6eb6/10010104/3f11c8c21792/fonc-13-1041396-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6eb6/10010104/7e2f1595e411/fonc-13-1041396-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6eb6/10010104/37ae77d1d0b5/fonc-13-1041396-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6eb6/10010104/1da0c8d6e674/fonc-13-1041396-g006.jpg

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J BUON. 2021 Jan-Feb;26(1):39-50.
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Management and outcomes of anastomotic leakage after McKeown esophagectomy: A retrospective analysis of 749 consecutive patients with esophageal cancer.麦氏食管癌根治术后吻合口瘘的处理及转归：749 例食管癌患者的回顾性分析。
Surg Oncol. 2020 Sep;34:304-309. doi: 10.1016/j.suronc.2020.06.002. Epub 2020 Jun 30.
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Benefit of salvage total pharyngolaryngoesophagectomy for recurrent locally advanced head and neck cancer after radiotherapy.
挽救性全咽-喉-食管切除术治疗放疗后复发局部晚期头颈部肿瘤的获益。
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Ann Surg. 2017 Jan;265(1):130-136. doi: 10.1097/SLA.0000000000001599.
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