摘要
目的:探讨食管癌患者经微创McKeown术后胸腔胃和纵隔胃的形成对心肺并发症的影响及其机制。方法:采用回顾性队列研究方法,选取2017年12月至2020年9月郑州大学第一附属医院行微创McKeown手术的697例食管癌患者,根据术后复查胸部CT的影像资料,分为胸腔胃(管状胃部分或全部位于胸腔内)和纵隔胃(管状胃位于后纵隔食管床内)两组。通过对比分析两组的一般临床特征、手术相关变量及术后心肺并发症的发病率,探讨行微创McKeown术后两种管状胃位置的形成机制及其与心肺并发症的关系。结果:对比两组手术变量,纵隔胃组的胃切除面积方面大于胸腔胃组[(65.7±38.2)cm2 vs.(55.0±31.7)cm2,P<0.001],管状胃宽度[(3.3±0.7)cm vs.(4.1±1.1)cm,P<0.001]和胃胸比(管状胃宽度和胸腔宽度的比值)[(0.30±0.1)vs.(0.39±0.1),P<0.001]均为纵隔胃组小于胸腔胃组。对比两组术后并发症,肺不张(36.0%vs. 54.2%,P<0.001)、胸腔积液(40.7%vs. 53.8%,P=0.001)和心血管并发症(16.0%vs. 22.3%,P=0.042)的发病率纵隔胃组较胸腔胃组低,而气胸、皮下积气、呼吸衰竭、吻合口瘘及吻合口狭窄的发病率和一般临床特征两组间差异无统计学意义(P>0.05)。结论:行食管癌微创McKeown手术时,纵隔胃的形成可以降低肺不张、胸腔积液和心血管并发症的发病率,胃切除面积与两种管状胃的形成有关,当胃切除面积较大时更易形成纵隔胃。
Objective: To investigate the effect and mechanism of thoracic gastric tube and posterior mediastinal gastric tube formation on cardiopulmonary complications in patients who underwent minimally invasive McKeown surgery for esophageal carcinoma. Methods: This retrospective cohort study included 697 patients with esophageal carcinoma who underwent minimally invasive McKeown surgery in The First Affiliated Hospital of Zhengzhou University from December 2017 to September 2020. Based on postoperative chest computed tomography data, the following two groups were defined: thoracic gastric tube(tubular stomach partially or completely located in the thoracic cavity) and posterior mediastinal gastric tube(tubular stomach located in the posterior mediastinal esophageal bed). To assess the formation mechanism of two types of tubular stomach after minimally invasive Mckeown surgery and examine their relationship with cardiopulmonary complications, comparative analysis of general clinical features, operation-related variables, and incidence of postoperative cardiopulmonary complications was performed between the two groups. Results: Comparison of operative variables between the two groups revealed that the gastrectomy area was larger in the posterior mediastinal gastric tube group than in the thoracic gastric tube group[(65.7±38.2) cm2 vs.(55.0±31.7) cm2, P<0.001], and the width of the tubular stomach [(3.3±0.7) cm vs.(4.1±1.1) cm, P<0.001] and the stomach-chest ratio(i.e., the ratio of tubular gastric width to thoracic width) [(0.30±0.1) vs.(0.39±0.1), P<0.001] were smaller in the posterior mediastinal gastric tube group than in the thoracic gastric tube group. The incidence of postoperative complications was lower in the posterior mediastinal gastric tube group than in the thoracic gastric tube group, and the incidences of atelectas is(36.0% vs. 54.2%,P<0.001), pleural effusion(40.7% vs. 53.8%, P=0.001), and cardiovascular complications(16.0% vs. 22.3%, P=0.042) were lower in the posterior mediastinal gastric tube group than in the thoracic gastric tube group. However, there were no significant differences between the two groups with respect to the incidence and general clinical characteristics of pneumothorax, subcutaneous pneumothorax, respiratory failure, anastomotic fistula, anastomotic stenosis(P>0.05). Conclusions: During minimally invasive McKeown surgery for esophageal carcinoma, the formation of posterior mediastinal gastric tube can reduce the incidence of atelectasis, pleural effusion, and cardiovascular complications. The gastrectomy area is related to the formation of two types of tubular stomach, and posterior mediastinal gastric tube is more likely to be formed when the gastrectomy area is larger.
作者
叶飞
李源奇
张静
张国庆
侯志超
李强明
罗文卿
李向楠
Fei Ye;Yuanqi Li;Jing Zhang;Guoqing Zhang;Zhichao Hou;Qiangming Li;Wenqing Luo;Xiangnan Li(Department of Thoracic Surgery,The First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Xiangya School of Public Health,Central South University,Changsha 410083,China;Department of Operation,The First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)
出处
《中国肿瘤临床》
CAS
CSCD
北大核心
2021年第13期664-669,共6页
Chinese Journal of Clinical Oncology
基金
国家自然科学基金(编号:32070623)
郑州大学学科建设重点专项项目(编号:XKZDQY202006)资助。
关键词
食管癌
微创McKeown手术
胸腔胃
纵隔胃
心肺并发症
esophageal carcinoma
minimally invasive Mckeown surgery
thoracic gastric tube
posterior mediastinal gastric tube
cardiopulmonary complications
