Search

Application of Pleural Tenting in Ivor-Lewis Esophagogastrectomy: A Randomized Controlled Trial

ObjectiveTo explore the superiority of pleural tenting in Ivor-Lewis esophagogastrectomy. MethodsWe prospectively included 200 esophagus cancer patients with Ivor-Lewis esophagogastrectomy in our hospital between 2013 and 2015 year. The patients were allocated into two groups including a trial group and a control group with 100 patients in each group. There were 72 males and 28 females at an average age of 54.76±6.62 years in the trial group and 66 males and 34 females at an average age of 55.72±6.38 years in the control group. In the trial group pleural tenting was used to cover the anastomotic stoma and gastric tube, while in the control group pleural tenting was not used. Postoperative complications after one year, pressure on the level of the anastomotic stoma, and the grade of quality of life were compared between the two groups. ResultNo statistically significant differences were found in preoperative epidemiological and postoperative pathological characteristics, as well as the postoperative complications and the one-year survival rate (P > 0.05). Quality of life was better in the trial group than that of the control group. ConclusionPleural tenting is a simple, safe, and effective technique for improving quality of life of the patients.

Occlusion Treatment of Clinically Symptomatic Leaks of Thoracic Esophageal Anastomoses under Gastroscope

目的总结腔内封堵技术治疗食管癌术后吻合口瘘的应用经验。 方法回顾性分析2006年8月至2011年12月上海中医药大学附属曙光医院应用腔内封堵技术治疗食管癌术后吻合口瘘15例患者的临床资料，其中男12例、女3例，年龄47～73岁。分析其临床效果。 结果窦道造影证实于瘘口附近有窦道形成者，瘘口直径＜0.5 cm者10例一次堵漏成功；瘘口直径大于0.5 cm者1例，堵漏二次后成功。瘘口附近窦道形成不明显者4例，堵漏均失败。 结论腔内封堵技术治疗食管癌术后吻合口瘘有相当的临床效果。瘘口附近有窦道形成是堵瘘成功的关键。

食管癌术后消化道瘘的个体化治疗

目的 总结食管癌术后消化道瘘的治疗经验，探讨其个体化治疗方法。 方法 2004年1月至2009年11月中山市人民医院收治食管癌患者并行食管癌切除、胃食管吻合术338例，术后出现消化道瘘22例(6.51%)，全组患者均为男性，年龄44~77岁，中位年龄62岁。颈部吻合口瘘8例，胸内吻合口瘘11例，胸胃瘘3例。再次手术治疗5例，植入食管支架2例，保守治疗15例。 结果 治疗时间5~181 d，平均47.0 d，主要并发症为肺部感染11例、呼吸衰竭5例、败血症3例；死亡7例，病死率31.8％（7/22）。5例再次手术治疗，其中死亡3例，治愈1例，再发生瘘1例，改保守治疗后治愈；2例经支架治疗均治愈；保守治疗15例，其中10例治愈，治疗时间20~73 d，平均46.3 d。 结论 对食管癌术后消化道瘘的局部处理，应根据患者瘘发生的时间、部位、瘘口大小和局限程度等给予个体化治疗。

食管瓣片成形——食管胃套接术的临床应用

目的 探讨消除食管胃吻合术后吻合口瘘、吻合口狭窄及胃反流等手术方法. 方法 食管两侧纵行剪开1.5cm,形成二叶瓣片.胃前壁造口为套接口,将二叶瓣片经胃套接口确保完全置入胃腔内.不缝粘膜层,仅将食管肌层与胃壁浆肌层做双层间断缝合,二层间距为3cm,以食管胃套接术代替食管胃吻合术. 结果 临床应用176例,无手术死亡,无吻合口瘘,无吻合口狭窄及胃反流,效果满意. 结论 (1)缝合粘膜层是食管胃吻合术后发生吻合口瘘的重要原因之一;(2)食管瓣片成形--食管胃套接术,不缝粘膜层,以套接术代替吻合术,能消除吻合口瘘,吻合口狭窄及胃反流三大并发症.

Analysis of Postoperative Complications and Cause of Death for Carcinoma of Esophagus

Objective To analyse postoperative complications and cause of death for carcinoma of esophagus. Methods A retrospective study was undertaken for data of 2 085 patients with esophageal carcinoma from 1963 to 2003, the patients were divided into group A (332 cases,1963-1983), group B(727 cases,1984-1993) and group C (1 026 cases,1994-2003) by time. The postoperative complications and cause of death were analysed. Results Resectability rate, incidence rate of postoperative complications and hospital mortality were 90.84%(1 894/2 085), 11.61% (242/2 085) and 1.82% (38/2 085) respectively. Main complications were pulmonary complications (3.93%,82/2 085),anastomotic leak (3.12%,59/1 894), and cardiovascular disease (1.29%,27/2 085). Resectability rate of group B and group C were higher than that of group A, incidence rate of postoperative complications and hospital mortality of group B and group C were lower than that of group A. Resectability rate of group C were higher than that of group B, incidence rate of postoperative complications except pulmonary complications and hospital mortality of group C were lower than those of group B. Conclusions Pulmonary complications and anastomotic leak are main postoperative complications and cause of hospital death for carcinoma of esophagus, they are decreasing in recent years because of the progress of anesthetic,surgical technique and perioperative management.

金陵术后并发吻合口瘘患者肠内营养护理一例

带膜食管支架置入治疗食管癌术后胸内食管吻合口瘘

目的　总结覆硅胶膜镍钛合金食管支架置入治疗食管癌术后胸内食管吻合口瘘的临床经验。方法　回顾性分析 2005年 1月至 2009年 12月上海交通大学医学院附属仁济医院 12例食管癌手术后发生胸内食管吻合口瘘经覆硅胶膜镍钛合金食管支架置入治疗的临床资料，其中男 7例，女 5例；平均年龄 65（45～ 70）岁。胸内食管吻合口瘘发生于术后第 5～ 28 d，均为单个漏口，漏口直径约 0.2～ 1.0 cm。确诊食管吻合口瘘后给予支持治疗 7 d，待病情稳定后置入覆硅胶膜镍钛合金食管支架，支架长 5～ 12 cm ，内径 1.8～ 2.0 cm。结果　术后因进食呛咳死于肺部感染 1例。术后出现胸骨疼痛 7例，支架移位 3例，消化道出血 1例，均经相应的治疗后好转或治愈。生存患者于置入食管支架后第 3～ 15 d经口进食。随访 11例，随访时间 1～ 6个月，食管吻合口瘘愈合良好 9例；支架移位 1例，瘘口未愈合，术后 4个月死于肿瘤复发；在回收食管支架过程中黏膜撕裂，致吻合口狭窄 1例。结论　带膜食管支架置入是治疗食管癌术后胸内食管吻合口瘘的一种有效方法。

食管、贲门癌切除器械吻合术519例

目的 总结食管、贲门癌切除后应用器械吻合防止吻合口瘘和狭窄的临床经验。方法 回顾性地分析519例食管、贲门癌患者应用吻合器治疗的结果。结果 发生并发症7例，包括吻合口瘘2例，吻合口出血2例，吻合口狭窄3例，无手术死亡和住院死亡。结论 器械吻合完整快捷，明显地减少了手术操作时间和吻合口并发症的发生，降低了手术死亡率。

改良食管胃吻合方法的临床应用

目的 预防食管、贲门癌手术后吻合口瘘和吻合口狭窄的发生.方法 将358例食管、贲门癌患者随机分为两组,研究组和对照组.研究组:178例采用可吸收缝合线做单层(全层)连续吻合,并用带蒂大网膜包绕吻合口;对照组:180例常规食管胃丝线间断缝合加食管壁与胃壁包裹.结果 术后研究组无1例发生吻合口瘘和严重的吻合口狭窄,对照组发生吻合口瘘5例(2.78%),发生严重吻合口狭窄6例(3.33%);两组比较有差异(P＜0.05).结论 食管胃吻合口用可吸收线单层(全层)连续吻合并用带蒂大网膜包绕,方法简便,疗效确切,可预防食管胃吻合口瘘和吻合口狭窄的发生.

Different intrathoracic anastomotic strategies for proximal esophageal dilatation in 654 patients with esophageal: A retrospective cohort study

Objective To explore the strategy of intrathoracic anastomosis in patients with esophageal squamous cell carcinoma when the proximal esophagus is dilated to different degrees and explore its mechanism. Methods We retrospectively reviewed the clinical data of patients who underwent esophagectomy between 2014 and 2017 in West China Hospital. The patients were divided into two groups including a significant dilatation group with inner mucosal phase diameter (IMPD)≥17.9 mm and a non-significant dilatation group with IMPD<17.9 mm. And the patients were divided into two groups (a layered manual anastomosis group and a stapled anastomosis group) according to anastomosis method and propensity score matching was applied to adjust for potential confounders. Results We finally included 654 patients. There were 206 patients with 158 males and 48 females at average age of 62.21±7.72 years in the layerd manual analstomosis group and 448 patietns with 377 males and 71 females at average age of 62.57±8.42 years in the stapled anastomosis group. We also used Masson trichrome staining to assess the collagen fiber content in the esophagus. Compared with layered manual anastomosis, the incidence of anastomotic leakage was higher in the significant dilatation group than that in the stapled anastomosis group (original cohort: 3.8% vs. 10.7%, P=0.093; propensity score-matched cohort: 1.4% vs. 15.3%, P=0.004). And there was no significant difference in anastomotic leakage b etween layered manual anastomosis and stapled anastomosis in the non-significant dilatation group (original cohort: 4.7% vs. 4.2%, P=0.830; propensity score-matched cohort: 4.8% vs. 4.0%, P=0.206). Moreover, the average collagen fiber area ratio was significantly lower in the significant dilation group than that in the non-significant dilatation group (P=0.045). Conclusion There is a significant reduction in collagen fibers in the proximal esophageal wall tissue of esophageal squamous cell carcinoma patients with a IMPD≥17.9 mm. Intrathoracic layered manual anastomosis effectively reduces postoperative anastomotic leakage in these patients.