姚梦旭　　郑世营　　万翼龙　　蒋东

[关键词] 食管癌;术后吻合口瘘;食管黏膜延长;食管吻合方式

[中图分类号] R735.1          [文献标识码] B          [文章编号] 1673-9701（2021）16-0114-03

Clinical research on prevention of esophageal anastomosis fistula by prolonged esophageal mucosa

YAO Mengxu   ZHENG Shiying   WAN Yilong   JIANG Dong

Department of Chest Surgery， the First Affiliated Hospital of Soochow University， Suzhou   215000， China

[Abstract] Objective To research the possibility in prevention of esophageal anastomosis fistula by prolonged esophageal mucosa. Methods The clinical data of 205 patients with esophageal cancer undergoing surgical treatment admitted to our hospital from January 2018 to December 2019 were analyzed retrospectively， and they were divided into the observation group （n=65） and the control group （n=140）. Among them， patients with esophageal cancer in the observation group were treated with prolonged esophageal mucosa surgery， while those in the control group were treated with conventional surgery. The basic clinical data， surgical time， intraoperative bleeding volume and incidence of postoperative esophageal anastomosis fistula were compared between patients in the two groups. Results There was no statistically significant difference in the basic clinical data between the two groups（P>0.05）. The operation time in the observation group was shorter than that in the control group， with statistically significant difference（P<0.05）， and there was no statistically significant difference in the intraoperative blood loss between the two groups（P>0.05）. The incidence of esophageal anastomosis fistula in the observation group was 3.08%，which was significantly lower than that of 12.86% in the control group，with statistically significant difference（P<0.05）. Conclusion Prolonged esophageal mucosa can effectively prevent the occurrence of postoperative esophageal anastomosis fistula after esophageal cancer，which is a new method of esophagogastrostomy in a sense.

[Key words] Esophageal cancer; Postoperative esophageal anastomosis fistula; Prolonged esophageal mucosa; Esophageal anastomosis mode

食管癌占全球惡性肿瘤发病率的 1%～2%[1]，在世界常见癌症中占第6位，且发病率逐年增加。我国年均新发食管癌病例占全球50% 以上，病死率则位居恶性肿瘤的第4位[2]。食管癌主要组织学类型有鳞癌和腺癌2种，发生在日本、中国和东亚国家90%以上的食管癌为鳞状细胞癌。手术治疗不仅可以彻底切除癌变组织，同时还能清扫相应引流区域的淋巴结，从而延长患者的生存期并提高生活质量。因此，根治性手术仍然是治疗食管癌的首选。目前随着医疗技术的快速发展，已有多种替代治疗可以取代手术治疗，但外科手术治疗依然是主要治疗手段，食管癌的手术方式较多，合理的手术方式应尽可能满足肿瘤彻底切除、淋巴结彻底清扫以及减少手术并发症，然而食管癌的术后并发症特别是食管吻合口瘘的发生率一直居高不下。本研究主要观察食管黏膜延长预防食管吻合口瘘的效果，以期改善食管癌患者的预后情况，现报道如下。

1 资料与方法

1.1 一般资料

回顾性分析2018年1月至2019年12月在本院胸外科接受手术治疗的205例食管癌患者的临床资料。纳入标准：①术前有明确的胃镜病理报告提示为食管恶性肿瘤;②术中采用管胃制作方法;③吻合方式为食管-管胃端侧器械吻合。排除标准：①术前检查发现远处转移无手术指征者;②合并有其他恶性肿瘤者;③合并严重的心肺器质性疾病者;④术前辅助放化疗者。按……