Experience Of Improving Anastomosis And Embedding In Preventing Intrathoracic Anastomotic Leakafter Sweet Esophagogastrectomy

Objective: Combine with literatures and analyzecomprehensively of the main factors affecting the occurrence of intrathoracic anastomotic leak after radical operation of esophageal carcinoma.Explore whether the surgical technique of "improved esophageal-tubular stomach anastomosis" combined with "annular nested embedding" has a positive effect on the prevention of intrathoracic anastomotic leak after esophagogastrectomy.Methods : We designed a prospective randomized controlled trial included 200 patients,whom all had esophageal squamous cell carcinoma in the lower esophagus and had Sweet esophagogastrectomy from November 2014 to November 2016 in our department of thoracic surgery.We divided the patients into two groupsrandomly: the control group and the trial group.The control group of patients a total of 100 people,92 men and 8 women.They were cut into the tubular stomach parallel to the long axis below the proximal end of the tubular dissection line,and placed stapler to anastomose esophageal with tubular stomach end-to-side.We made multi-point reinforced suture to anastomosis.We closed and embedded the incision on the stomach wall.The trial group of patients a total of 100 people,94 men and6 women.They were cut into the tubular stomach perpendicular to the long axis top of the tubular stomach and placed stapler.Then folded the stomach and anastomose esophageal with tubular stomach end-to-side.We raised the tubular stomach and made its wall cover the anastomosis by 2 to 3cm,andsutured and embedded the highest part of the stomach pleat with esophagus.Used stapler cut and closed the incision and its surrounding tissue.The two groups of patients were obligated mediastinal drainage tubes;and were given early enteral nutrition after their operations.We made these two groups of patients oral methylene blue form 4th day to 7th day after esophagogastrectomy.It was determined as anastomotic leak whenever there was one time that the intrathoracic or mediastinal drainage tube was dyed blue.For some patients with the situation that they got 4 times negative in methylene blue test,we would add another test before pulled out their drainage tubes.We considered some patients that they had no anastomotic leak if they got 5 times negative in the test.For patients who were confirmed the anastomotic leak,we would record and analysis their data which included group,number,gender and pathological stage.We referred to esophageal cancer TNM International Staging 7th Edition as the pathological stage.Using the software SPSS 21.0 to analysis these data.Set ?=0.05 as an inspection standards.P <0.05 indicates that the difference is statistical significant.Results: The general condition of these two groups of patients is similar(P>0.05).It has no statistical difference and can compare with each other.The difference between male and female,under other equivalent conditions,has no statistical difference in the case of occurring postoperative thoracic anastomotic leak(P>0.05).The improvement of anastomosis and embedding can reduce the incidence of occurring postoperative thoracic anastomotic leak.It indicates that the difference between control group and test group is statistical significant(P < 0.05).The difference between different pathological stage,under other equivalent conditions,is statistical significant in the case of occurring postoperative thoracic anastomotic leak(P>0.05).The later the stage,the higher the incidence.Conclusions: The techniquescombining "improved esophageal-tubular stomach anastomosis" and "annular nested embedding" can actively and effectively prevent the intrathoracic anastomotic leak after Sweet esophagogastrectomy.It is athree-in-one technology to prevent the intrathoracic anastomotic leak after Sweet esophagogastrectomy while presetting mediastinal drainage tube.The three-in-one technology improve blood supply to anastomosis and reduceanastomotictension and create a superiorpartial environment for anastomosis to union.It is a comprehensive,simple and effectivemethod.And it is worthy of promotion.