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目的 探讨食管胃吻合口并发症减少的真正原因。方法 １９８４ 年６ 月至１９９７ 年６ 月共手术切除食管癌和贲门癌５ １１９ 例，将前７ 年（１９８４ 年至１９９１ 年） 和后６ 年（１９９１ 年至１９９７ 年） 分为Ａ、Ｂ二组进行对比研究。结果 吻合口瘘、吻合口狭窄和返流性食管炎的发生率，Ａ组分别为４－２％ 、４－８６％ 和１５－５ ％ 。Ｂ组分别为１－０１ ％ 、２－１３％ 和７－０３％ 。Ａ 组吻合口瘘的死亡率为３９－３５ ％ ，Ｂ组无吻合口瘘死亡。二组并发症相比较有显著性差异（ Ｐ＜ ０．０１） 。Ａ、Ｂ二组的吻合方法我重要改变，只是吻合部位从胸腔上移至颈部。结论 吻合口并发症下降的原因是吻合技术的提高，与吻合方法关系不大。颈部吻合的最大优点是降低了吻合口瘘的死亡率。
Objective To investigate the real cause of the decrease in complications of esophagogastrostomy. Methods From June 1984 to June 1997, a total of 5 119 cases of esophageal and cardiac cancer were surgically resected. The first 7 years (1984 to 1991) and the last 6 years (1991 to 1997) were divided into A and B. The groups were compared for study. Results The incidence of anastomotic leakage, anastomotic stricture, and reflux esophagitis was 4-2%, 4-86%, and 15-55% in group A, respectively. Group B was 1-01%, 2-13%, and 7-03%, respectively. The mortality rate of anastomotic fistula in group A was 39-35 %, and there was no anastomotic fistula death in group B. There was a significant difference between the two groups of complications (P < 0.01). The anastomosis of group A and group B changed significantly, except that the anastomosis site moved from the chest to the neck. Conclusion The decrease of anastomotic complications is due to the improvement of the anastomosis technique and has little to do with the anastomosis method. The biggest advantage of neck anastomosis is to reduce the mortality of anastomotic fistulas.