目的

探讨颈部三角吻合术和侧侧吻合术在全腔镜食管切除术后防止发生吻合口并发症的有效性。

方法

选择2015年10月—2017年10月在山西医科大学汾阳医院心胸外科行胸腹腔镜联合食管切除、胃颈部吻合的120 例食管癌患者，其中腔镜用切割缝合器三角吻合术组65 例，腔镜用切割缝合器侧侧吻合术组55 例，比较两组患者术后吻合口瘘、吻合口狭窄和反流性食管炎的发生率。

结果

三角吻合术组患者术后吻合口瘘、吻合口狭窄、反流性食管炎的发生率分别为0、3 .1% 和30 .8% ，侧侧吻合术组分别3 .6% 、5 .5 和10 .9% 。统计学分析显示，侧侧吻合组患者术后反流性食管炎的发生率显著高于三角吻合组，差异有统计学意义（P＜0 .01）；但两组间吻合口瘘和吻合狭窄的发生率比较，差异无统计学意义（P＞0 .05）。

结论

颈部三角吻合术和侧侧吻合术在食管癌手术后吻合口瘘、吻合口狭窄发生率都较低，但侧侧吻合术后反流性食管的发生率更低。

Objective

The objective of this study is to investigate the effectiveness of cervical triangle anastomosis and lateral anastomosis in preventing anastomotic complications after total thoracoscopic and laparoscopic esophagectomy .

Methods

Retrospective analysis was performed on 120 cases of esophageal cancer patients who underwent combined thoracoscopic and laparoscopic esophagectomy and cervical esophagogastric anastomosis in Fenyang Hospital from October 2015 to October 2017 .Among the 120 cases ,65 cases were treated with triangular anastomosis while 55 cases were treated with lateral anastomosis . The incidences of anastomotic fistula ,anastomotic stricture and reflux esophagitis were compared between the two groups .

Results

The incidences of anastomotic fistula ,stenosis and reflux esophagitis in the triangle anastomosis group was 0 ,3 .1% and 30 .8%respectively ,while the data was 3 .6% ,5 .5% and 10 .9% respectively in the lateral anastomosis group .Compared with the two groups , the incidence of postoperative reflux esophagitis was statistically significant different( P＜0 .05) ,whereas the incidences of anastomotic fistula and anastomosis stenosis was not ( P＞0 .05) .

Conclusions

Triangle anastomosis and lateral anastomosis both result in low incidences of postoperative anastomotic fistula and anastomosis stenosis ,while the postoperative incidence of reflux esophagus is ever lower after lateral anastomosis .