摘要
目的探讨弧形切割闭合器联合经口置入钉砧头系统在SiewertⅡ型食管胃结合部腺癌（AEG）根治术中的应用价值。方法采用回顾性横断面研究方法。收集2011年3月至2016年3月河南省肿瘤医院收治的206例SiewertⅡ型AEG患者的临床病理资料。患者均行AEG根治术，施行三阶段顺时针全胃切除＋D＇淋巴结清扫术。观察指标：（1）手术及术后恢复情况：手术入路、总体手术时间、钉砧头放置时间、食管空肠吻合时间、术中出血量、淋巴结清扫数目、术后肛门排气时间、术后并发症情况、术后住院时间。（2）术后病理学检查及化疗情况。（3）随访和生存情况。采用电话与门诊相结合的方式随访，随访内容为患者无瘤生存情况。随访时间截至2016年4月。正态分布的计量资料采用牙±s表示。采用Kaplan—Meier法计算生存率。结果（1）手术及术后恢复情况：206例患者均顺利完成手术，经腹手术85例，经腹切开膈肌进胸手术50例，胸腹联合手术71例。206例患者总体手术时间为（113．7±15．4）min，钉砧头放置时间为（3．5±1．2）min，食管空肠吻合时间为（10．4±2．9）min，术中出血量为（128±25）mL，淋巴结清扫数目为（32±6）枚，术后肛门排气时间为（2．4±0．9）d。206例患者中，15例发生术后并发症，其中隐性吻合口瘘6例、显性吻合口瘘3例、胰液漏2例、肠梗阻2例、吻合口狭窄1例、胸腹腔感染1例，并发症均经保守治疗后痊愈。无围术期因并发症再次行手术治疗患者。206例患者术后住院时间为（12．3±1．9）d。（2）术后病理学检查及化疗情况：206例患者食管切缘距肿瘤距离为（5．2±0．4）cm，切缘均无癌细胞残留。171例患者术后接受替吉奥联合奥沙利铂方案化疗6-8个周期，或口服单药替吉奥1年。（3）随访和生存情况：206例患者均获得术后随访，随访时间为（2
Objective To investigate the application value of the curved cutter stapler device combined with trans-orally inserted anvil （OrVil） in the radical resection of Siewert type II adenocarcinoma of the esophagogastric junction （AEG）. Methods The retrospective cross-sectional study was conducted. The clinieopathological data of 206 patients with Siewert type iI AEG who were admitted to the Henan Tumor Hospital between March 2011 and March 2016 were collected. All the 206 patients underwent radical resection and 3-step clock wise total gastrectomy ＋ D2 lymph node dissection. Observation indicators ： （ 1 ） surgery and postoperative recovery situations： surgical approach, overall operation time, hammer anvil placing time, esophagojejunal anastomosis time, volume of intraoperative blood loss, number of lymph node dissected, time to anal exsufflation, postoperative complications and duration of postoperative hospital stay; （2） postoperative pathological examination and chemotherapy; （3） follow-up and survival situations. Follow-up using telephone interview and outpatientexamination was performed to detect tumor-free survival of patients up to April 2016. Measurement data with normal distribution were represented as .~＋~. The survival rate was calculated by the Kaplan-Meier method. Results （ 1 ） Surgery and postoperative recovery situations .. all the 206 patients received successful operations, including 85 with abdominal operation, 50 with abdominal incision through the diaphragmatic muscle into thoracic surgery and 71 with thoracic-abdominal surgery. Overall operation time, hammer anvil placing time, esophagojejunal anastomosis time, volume of intraoperative blood loss, number of lymph node dissected, time to anal exsufflation and duration of hospital stay were （ 113.7-＋ 15.4 ） minutes, （ 3.5-＋ 1.2） minutes, （ 10. 4＋ 2.9） minutes, （ 128-＋ 25 ） mL, 32＋ 6, （ 2.4__＋ 0. 9） days and （ 12.3 -＋ 1.9） days, respectively. Of 206 patients, 15 with postoperative
出处
《中华消化外科杂志》
CAS
CSCD
北大核心
2017年第5期459-463,共5页
Chinese Journal of Digestive Surgery
基金
河南省科技攻关项目（201403214）
