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目的探讨食管胃前壁单层吻合预防食管癌术后吻合口狭窄的价值。方法常规经二切口或三切口行食管癌根治性切除,区域淋巴结清扫后,将胃经食管床上提至颈部,于胃底作一长约3～4cm切口(略大于食管切缘),分别距食管断缘及胃底切口缘约1cm处行食管后壁肌层和胃后壁浆肌层固定3针,然后行食管后壁断缘和胃底切口后壁缘间断全层吻合,针距约0.3～0.5cm,边距(针距切缘)约为0.5cm。再用褥氏内翻吻合食管前壁断缘和胃底切口前壁缘。边距(针距切缘)约为0.5cm,褥氏内针距为0.5～1.0cm,褥氏外针距为0.3～0.5cm。食管胃前壁不做包埋加固。为防吻合口掉入胸腔,可将胃前壁固定2针于颈前肌群上。最后常规放置引流管后,缝闭颈部切口及关胸,关腹。结果本组167例,无手术死亡,吻合口瘘发生率1.8%(3/167),经保守治疗愈;无吻合口出血,术后开始进食时间与传统吻合方式相比无差别。术后3个月随访吻合口狭窄发生率3.0%(5/167);经扩张治疗后均能进软食,术后6个月167例随访均能进软食,有胸骨后烧灼感或返酸等返流症状者11例(发生率6.6%)。结论该方法有效降低了吻合口狭窄发生率,而且简化了手术操作步骤,未增加其他并发症的发生率。
Objective To investigate the value of esophagogastrostomy anastomosis to prevent anastomotic stricture after esophagectomy. Methods Routine resection of esophageal cancer by two incisions or three incisions was performed. After regional lymphadenectomy, the stomach was raised to the neck through the esophageal bed and incised for about 3-4 cm in the gastric fundus (slightly larger than the esophageal incision) From the edge of the esophagus and the fundus incision edge about 1cm at the esophageal wall and the posterior gastric wall myoblasts fixed 3-pin, and then line esophageal posterior wall and gastric fundus incision wall edge interrupted full-thickness anastomosis, needle pitch About 0.3 ~ 0.5cm, margin (pitch from the edge) is about 0.5cm. Then use of mattress flap anastomosis anterior esophageal wall and gastric fundus incision wall. Margins (stitch cutting edge) is about 0.5cm, mattress within the needle spacing of 0.5 ~ 1.0cm, mattress outside the needle is 0.3 ~ 0.5cm. Esophagogastric anastomosis without embedding. In order to prevent anastomosis fall into the chest, the stomach can be fixed in the anterior 2 needle on the front muscle. After the conventional drainage tube placed after the closure of the neck incision and off the chest, closed abdomen. Results 167 cases of this group, no operative mortality, anastomotic leakage rate of 1.8% (3/167), conservative treatment; no anastomotic bleeding, postoperative start of eating time compared with the traditional anastomosis was no difference. The incidence of anastomotic stenosis was 3.0% (5/167) at 3 months after operation. All patients were able to eat soft food after dilation. 167 cases at 6 months after operation were able to eat soft food, had retrosternal burning sensation or acid reflux 11 cases of reflux symptoms (6.6% incidence). Conclusion The method effectively reduces the incidence of anastomotic stenosis, and simplifies the surgical procedures, did not increase the incidence of other complications.