摘要
目的探讨胃大网膜联合创面封闭胶在预防胸内吻合口瘘的效果。方法将2008年8月至2012年9月在我院手术治疗的560例食管贲门癌患者采用随机数字表法分为常规组及观察组各280例，常规组：食管胃胸内机器吻合后在吻合口外周间断褥式缝合加固。观察组：食管胃胸内机器吻合后在吻合口外周间断褥式缝合后，用胃大网膜包绕吻合口外周，再用创面封闭胶喷洒固定，同时将胃体固定于胸主动脉及后胸壁。对比两组临床效果。结果常规组发生胸内吻合口瘘8例，发生率2．86％（8／280），其中有症状瘘7例，无症状的包裹瘘1例；7例经保守治疗治愈出院，1例由于感染加重自动出院。术后平均住院时间（55．6±30．5）d。吻合口狭窄11例（3．93％，11／280）。观察组发生胸吻合口瘘1例，发生率0．36％（1／280），为无症状包裹瘘，术后住院时间20d，治愈出院。吻合口狭窄8例（2．86％，8／280）。两组胸内吻合口瘘发生率比较差异有统计学意义（P=0．044），吻合口狭窄比较差异无统计学意义（P=0．484）。结论胃大网膜联合创面封闭胶预防胸内吻合口瘘的手术方法操作简单，可以明显减少胸内吻合口瘘的发生，吻合口狭窄无明显增加，而且胸内吻合口瘘的症状较轻，治愈时间短，宜在临床上推广使用。
Objective To investigate the effect of great omentum combined with medical obturation glue on preventing thoracic cavity anastomotic leakage. Methods From August 2008 to September 2012,560 patients with esophageal gastric cardial carcinoma were enrolled and divided into two groups ： the regular group （ n = 280） and the experimental group （n = 280）. In the regular group, anastomosis was reinforced with interrupted mattress sutures after esophageal gastric anastomosis was stapled. In the experimental group, anastomosis was covered with great omentum and medical obturation glue was sprayed to eonglutinate after reinforced with interrupted mattress sutures. After that, gastric corpus was fixed upon the thoracic aorta and posterior chest wall. The clinical effects of the two groups were compared. Results Intrathoraeic anastomotic leakage occurred in 8 cases （2. 86% （8/280）） of the regular group, including 7 cases with symptomatic leakage and 1 case with asymptomatie loculate leakage. Seven patients were cured with conservative treatment and 1 patient with severe infection left hospital without cure. Average length of hospital stay was （ 55.6 ± 30. 5 ） days postoperatively. Anastomotic stenosis occurred in 11 patients （ 3.93%, 11/280 ）. In the experimental group, one patient （ 0. 36%, 1/280 ） with asymptomatic loculate leakage was hospitalized for 20 days, and finally cured and discharged. 8 cases with anastomotic stenosis occurred in the experimental group （2. 86%, 8/280）. There was statistic difference in the rate of intrathoraeic anastomotic leakage between the two groups （ P = 0. 044 ）, but there was no statistic difference in anastomotic stenosis between the two groups （ P = 0. 484）. Conclusion The technique of great omentum combined with medical obturation glue for preventing thoracic cavity anastomotic leakage, which is easy to perform, can obviously decrease the occurrence and attenuate the symptom of intrathoracic anastomotic leakage, and anastomotic stenosis increases unobviously. It also can shorten the length of hospital stay and is worthy of clinical promotion.
出处
《中国综合临床》
2013年第8期839-841,共3页
Clinical Medicine of China
关键词
食管癌
贲门癌
吻合口瘘
大网膜
创面封闭胶
吻合口狭窄
Esophageal carcinoma
Gastric cardial carcinoma
Anastomotic leakage
Great omentum
Medical obturation glue
Anastomotic stenosis
