食管切除术中Y形分层抗反流吻合术
The Y-shaped layered antireflux anastomosis in esophagectomy.
文献信息
| PMID | 42785176 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Guoqing Zhang |
| 作者单位 | State Key Laboratory of Metabolic Dysregulation and Prevention and Treatment of Esophageal Cancer, Zhengzhou, Henan Province, China; Department of Thoracic Surgery, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China. |
| 期刊 | Surgery |
| SCI 分区 | Q1 |
| IF | 3.5 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 鼻科 |
中文摘要
背景： 吻合口并发症，包括吻合口漏、狭窄和反流，仍然是食管切除术后发病的主要来源，而现有技术未能充分解决这一三联问题。
目的： 描述一种新型Y形分层抗反流吻合术（Y形组），并与传统圆形吻合器吻合术（O形组）比较其初步结果。
设计： 对一家三级转诊中心前瞻性维护数据库的回顾性审查，纳入2025年1月至12月期间接受胸腹腔镜食管切除术联合胃管重建的连续患者。
干预： 手工缝合Y形吻合术对比圆形吻合器端侧吻合术。
结果： 在573例患者中（102例Y形，471例O形），Y形组年龄更大（66.1 vs 63.0岁；P < .001），cN3疾病更多（P = .006），肿瘤分化更好（P = .006）。Y形组的吻合口漏（1.0% vs 5.9%；P = .038）、狭窄（3.9% vs 12.3%；P = .013）、吞咽困难（4.9% vs 16.8%；P = .002）和有症状的反流（8.8% vs 23.1%；P = .001）均显著更低。Y形组术后住院时间更短（11.8 ± 2.98 vs 13.2 ± 7.96天；P = .003）。在6个月时，欧洲癌症研究与治疗组织生活质量问卷-食管癌模块18的平均吞咽困难评分（14.33 vs 20.92；P < .001）和反流评分（21.01 vs 31.86；P < .001）在Y形组显著更低。根据Clavien-Dindo分类的并发症严重程度分布在两组间相当（P = .636）。
结论与意义： Y形吻合术在技术上可行，并与较低的漏、狭窄、吞咽困难和反流发生率相关。这些发现值得前瞻性验证。
英文摘要
BACKGROUND: Anastomotic complications, including anastomotic leakage, stricture, and reflux, remain major sources of morbidity after esophagectomy, yet existing techniques inadequately address this triad of issues.
OBJECTIVE: To describe a novel Y-shaped layered antireflux anastomosis (Y-shaped group) and evaluate its preliminary outcomes compared with conventional circular-stapled anastomosis (O-shaped group).
DESIGN: Retrospective review of a prospectively maintained database from a tertiary referral center, including consecutive patients who underwent thoracolaparoscopic esophagectomy with gastric tube reconstruction between January and December 2025.
INTERVENTIONS: Hand-sewn Y-shaped anastomosis versus circular-stapled end-to-side anastomosis.
RESULTS: Among 573 patients (102 Y-shaped, 471 O-shaped), the Y-shaped group was older (66.1 vs 63.0 years; P < .001), had more cN3 disease (P = .006), and had better tumor differentiation (P = .006). Anastomotic leakage (1.0% vs 5.9%; P = .038), stricture (3.9% vs 12.3%; P = .013), dysphagia (4.9% vs 16.8%; P = .002), and symptomatic reflux (8.8% vs 23.1%; P = .001) were significantly lower in the Y-shaped group. Postoperative hospital stay was shorter in the Y-shaped group (11.8 ± 2.98 vs 13.2 ± 7.96 days; P = .003). At 6 months, mean dysphagia scores (14.33 vs 20.92; P < .001) and reflux scores (21.01 vs 31.86; P < .001) on the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Esophageal Cancer Module 18 were significantly lower in the Y-shaped group. The distribution of complication severity according to the Clavien-Dindo classification was comparable between groups (P = .636).
CONCLUSION AND RELEVANCE: The Y-shaped anastomosis was technically feasible and associated with lower rates of leakage, stricture, dysphagia, and reflux. These findings warrant prospective validation.