Application Of Cervical T-shaped Anastomosis In Radical Resection Of Middle And Lower Esophageal Carcinoma

Objective: to evaluate the effect of T-type anastomosis in thoracoscopic radical resection of middle and lower esophageal carcinoma Methods: 162 patients who underwent thoracoscopic-assisted cervical esophagogastrostomy in the Department of Thoracic surgery of the first affiliated Hospital of Fujian Medical University from April 2017 to December 2019 were analyzed retrospectively.There were 82 cases in T shaped total mechanical side-to-side esophagogastric anastomosisgroup(TSA group)and 80 cases in Manual layered anastomosis group(MLA group).The anastomosis time,operation time and intraoperative blood loss of the two groups were recorded.Neck drainage,neck drainage time,hospital stay,postoperative complications(including cardiopulmonary complications,recurrent laryngeal nerve injury,anastomotic leakage,anastomotic stricture,gastroesophageal reflux,etc.).Results: there was no conversion to thoracotomy in all patients,and there was no death after operation.1.There was no significant difference in the general data between the two groups(P > 0.05).The anastomosis time of TSA group and MLA group was 8.0 ±1.6min and 26.7 ±4.2minutes respectively,the difference was statistically significant(P <0.05).The operation time of TSA group and MLA group was 242.4±40.8min and 268.5 ±36.5 minutes respectively,the difference was statistically significant(P < 0.05).The hospitalization days of TSA group and MLA group were 12.6 ±2.4 days and 14.4 ±5.9 days respectively,the difference was statistically significant(P < 0.05).There was no significant difference in intraoperative blood loss,cervical drainage volume,time of cervical drainage tube extubation and postoperative food intake between the two groups(P > 0.05).The incidence of postoperative anastomotic stenosis in TSA group and MLA group was 0%(0/82)and 8.8%(7/73)respectively,and the difference was statistically significant(P < 0.05).The incidence of postoperative anastomotic fistula in TSA group and MLA group was 4.9%(4/78)and5%(4/76),respectively,and there was no significant difference between the two groups(P > 0.05).There was no significant difference in postoperative pulmonary complications,cardiovascular complications,recurrent laryngeal nerve injury and gastroesophageal reflux between the two groups(P > 0.05).Conclusion: T shaped total mechanical side-to-side esophagogastric anastomosiscan not only reduce the time of anastomosis and operation,but also reduce the incidence of postoperative stricture complications.it is a safe method of esophagogastric neck anastomosis worth popularizing.