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食管胃侧侧吻合预防吻合口狭窄的临床随机对照研究

Esophagogastrostomy by side-to-side anastomosis in prevention of anastomotic stricture:a randomized clinical trial

摘要:

目的 评价使用食管胃侧侧吻合术预防术后吻合口狭窄的效果.方法 2007年11月至2008年9月连续收治行食管癌、贲门癌切除术的患者160例,2例拒绝随机分组,3例不符合人选标准,其余155患者完全随机分组为食管胃侧侧吻合组、吻合器吻合组与手工吻合组,通过术后3个月食管造影测量吻合口直径确定吻合口狭窄的发生率(吻合口直径≤O.8 cm为吻合口狭窄).结果 术后死亡1例,行剖胸探查1例.术后并发吻合口漏4例(其中手工吻合3例,吻合器吻合1例).随访率为96.1%(失访6例,侧侧吻合组1例,手工吻合组3例,吻合器组2例).共144例患者进行了意向治疗分析(侧侧吻合组45例,手工吻合组52例,吻合器组47例).三组患者术前情况类似,侧侧吻合组术后吻合13狭窄率(0)低于手工吻合组(9.6%)及吻合器组(19.1%,Fisher 精确概率法,P=0.005),而三组之间的术后胃食管反流程度学差异无统计学意义(χ~2=1.681,P=0.432).结论 食管胃侧侧吻合术能够有效地预防吻合口狭窄,同时并不加重胃食管反流.

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abstracts:

Objective To compare a side-to-side esophagogastric anastomosis with conventional hand-sewn or stapled esophagogastrostomy for prevention of anastomotic stricture by randomized clinical trial.Methods Between November 2007 and September 2008,160 patients with esophageal carcinoma or gastric cardia cancer were consecutively admitted and underwent surgical treatment.After excluding 5 patients (2 refused to participate in and 3 did not meet inclusion criteria),the remaining 155 patients were completely randomized to receive either a side-to-side esophagogastric anastomosis(SS group),or the conventional hand-sewn(HS group),or a circular stapled(CS group)anastomosis,after the removal of esophageal tumor,The primary outcome measured the incidence of anastomotic stricture at 3 months after the operation(defined as the diameter of the anastomotie orifice≤0.8 cm on esophagogram),analyzed by intention-to-treat.Results There was 1 operative death(in HS group)and 1 simple exploration(in SS group).The anastomotic leakage was observed in 4 patients(2 cervical and 1 intrathoracic leaks in HS group,and 1 intrathoracic leak in CS group).The follow-up rate was 96.1%(1 patient in SS group,3 in HS group,and 2 in CS group were lost).Finally 45 patients in SS group,52 in HS group,and 47 in CS group were included in the analysis.The 3 groups were preoperative similar.The anastomotic stricture rate was 0%(0/45)in SS group,9.6%(5/52)in HS group,and 19.1%(9/47)in CS group,respectively (Fisher exact probability test,P=0.005).The reflux/regurgitation score among 3 groups was similar(χ~2=1.681,P=0.432).Conclusion The side-to-side esophagogastric anastomosis could prevent stricture formation,without increasing gastroesophageal reflux.

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