| Background and objectiveEsophageal cancer is a kind of malignant tumor of digestive system originate from the esophageal epithelium and esophageal glands,the incidence of EC has been ranked sixth in malignant tumors worldwide,ranked fifth in China,approximately 287 thousand new cases per year.The highest incidence and mortality area of EC worldwide is Linzhou,and Huixian in China’s Henan province.At present,the most effective method for the treatment of EC is surgical treatment.However,postoperative complications are easy to occur,especially anastomotic leakage,it is reported that the incidence of anastomotic leakage after EC surgery is about 3-5%,the mortality rate is as high as 11%.In order to reduce anastomotic complications,various anastomosis methods are proposed and applied to clinical.At present,the major methods of our hospital is the "cap like" seromuscular flap-covering manual anastomosis and mechanical anastomosis.In order to compare and analyze the incidence of postoperative complications and short-term postoperative quality of life of these two methods,a randomized controlled trial was designed,as well to providea theoretical basis for clinical selection.Materials and Methods194 cases of esophageal cancer patients in our hospital from October 2013 to October 2015 were randomly divided into two groups,of which 96 cases were treated by mechanical anastomosis,89 cases were esophageal squamous cell cancer,6 cases were glandular cancer and the other 1 cases were squamous cell carcinoma.98 cases were treated by manual anastomosis,86 cases were esophageal squamous cell cancer,9 cases were glandular cancer,and 2 cases were squamous cell carcinoma.The data of two groups were compared and analyzed.All the patients were followed up for more than 1 years,and the follow-up included the incidence of long-term complications.The quality of life of patients.has been judged through QLQ-C30 and QLQ-OES18.ResultsThe comparison between two groups on aspects of operation time(222.8 ±15.1min VS 210.9 ± 13.6 min),blood loss(195.6 ± 77.4ml VS 187.2 ± 69.1ml),Lymph node dissection(19.8±2.1 VS 21.3±2.4),duration of fasting(10.2±1.3d VS6.8 ± 1.1d),hospitalization(19.9 ± 1.9d VS 15.9 ± 2.0d),transfusion rate(3.1% VS4.2%)and ICU stay(7.1% VS 5.2%)shows no statistics differences(P > 0.05).The cost of operation(10652.4 ± 2317.6VS15727.6 ± 3985.2)and hospitalization(39958.3 ± 3687.3VS 43824.7 ± 6115.6)of manual anastomosis group was slightly lower than that of mechanical anastomosis group(P<0.05).The comparison between two groups on aspects of incidence of anastomotic leakage(8.2% VS 5.2%),incidence of anastomotic stenosis(4.1% VS 7.3%)incidence of pulmonary complications(11.2% VS 9.4%),incidence of RLN injury(4.1% VS 5.2%),incidence of chylothorax(3.1% VS 2.1%),incidence of arrhythmia(7.1% VS 9.4%),incidence of delay of gastric emptying(8.2% VS 6.3%),incidence of thoracic infections(1.0% VS 3.1%)shows no statistics differences(P>0.05).The incidence of,reflux esophagitis(3.1% VS 10.4%)in manual anastomosis group was slightly lower than that of mechanical anastomosis group(P<0.05).The emotional function and postoperative economic difficulties scores of manual anastomosis group were slightly better than those in mechanical anastomosis group,and the difference was statistically significant(P < 0.05).The reflux symptoms scores of seromuscular flap covering anastomosis group were slightly better than the mechanical anastomosis group,the difference was statistically significant(P < 0.05),but there was no significant difference in other items.ConclusionsThe operation cost,hospitalization cost,the incidence of reflux esophagitis of seromuscular flap covering anastomosis group were slightly lower than those of mechanical anastomosis group.There was no significant difference in operation time,postoperative fasting days,hospital days,the results of tumor and other complications.The emotional function score,economic difficulties score and reflux symptomsscores of manual anastomosis group were slightly better than the mechanical anastomosis group,but there was no significant difference in other items.In a word,seromuscular flap covering manual anastomosis is regarded as a method to be considered to be equivalent to mechanical anastomosis to treat esophageal cancer.However,the technical requirements of the manual anastomosis is considered higher than mechanical anastomosis. |
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