Application Of Mechanical Anastomosis And Manual Stratified Anastomosis In McKeown Surgery For Esophageal Carcinoma Combined With Video-assisted Thoracoscopy

Objective:To explore the application of mechanical anastomosis and manual stratified anastomosis in Mc Keown surgery for esophageal cancer performed by VIDEO-assisted thoracoscopy combined with laparoscopy.Method:Patients with esophageal cancer treated in our hospital from 2019 to 2021 were selected.After a series of pre-operative examination and preparation,quality control indicators were strictly established according to the current international surgical methods for esophageal cancer,with surgical indications(staging CT1-3N0-2M0),Mc Keown was selected for treatment according to the surgical standards.The two groups were randomly divided into mechanical anastomosis group(mechanical anastomosis group,n=40)and manual stratified anastomosis group(manual stratified anastomosis group,n=40).The incidence of postoperative complications and short-term postoperative quality of life of the two groups were analyzed to study the feasibility and reproducibility of thoracic laparoscopic Mc Keownneck manual stratified anastomosis.Result:1.There was no significant difference in age,gender,tumor location and stage(P>0.05).2.After comparison,there were significant differences in related indicators and postoperative complications between the manual stratified anastomosis group and the instrument anastomosis group(P<0.05).Among them,there were significant changes in the incidence of anastomotic leakage,operation time,and anastomotic stenosis.There were no significant differences in the number of harvested lymph nodes,intraoperative blood loss,chest drainage,postoperative hospital stay,respiratory failure,vocal cord paralysis,chylothorax,delayed gastric emptying,tracheal residual gastric fistula and death between the two groups(P>0.05).3.After comparison,the comparison results of gender,age,tumor location,pathological differentiation degree,preoperative albumin level,whether to receive radiotherapy and chemotherapy,whether to have hypertension,diabetes,respiratory diseases,and postoperative complications between the two groups of patients showed that,There was no significant difference in the end-to-end anastomosis and end-to-side anastomosis between manual stratified anastomosis(P>0.05).(4)It was found that the occurrence of anastomotic leakage had a statistically significant effect on the occurrence of anastomotic stenosis(b=4.710,OR=0.029,95%CI 18.982-649.271).With the occurrence of anastomotic leakage,the results were more likely to have anastomotic stenosis,OR<1,and the difference was statistically significant(P < 0.05).The occurrence of anastomotic leakage is an independent risk factor for anastomotic stenosis.Conclusion:1.There was no significant difference in age,gender,tumor site,stage and other general information.2.Manual stratified anastomosis in video-assisted thoracoscopic combined laparoscopic Mc Keown surgery for esophageal cancer has a low incidence of anastomose-related complications,which is a relatively safe surgical method.3.The comparison of manual stratified anastomosis with end-to-end anastomosis and end-to-side anastomosis showed that there was no statistical significance in the influence of the two methods on postoperative complications.4.The occurrence of anastomotic fistula is an independent risk factor for anastomotic stenosis.Manual stratified anastomosis during video-assisted thoracoscopic and laparoscopic Mc Keown surgery for esophageal cancer is a safer approach for patients with esophageal cancer.Of course,since the sample size of this study is relatively limited and it is a single-center trial,it needs to be verified by more large-sample multi-center clinical trials.