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目的探讨带血管弓单管空肠在食管胃结合部腺癌和胃中上部癌行全胃切除后食管-空肠Roux-en-Y吻合中处理吻合口张力的可行性。方法回顾性分析2012年12月至2013年4月期间,笔者所在医院应用带血管弓单管空肠处理食管胃结合部腺癌和胃中上部癌行全胃切除后食管-空肠Roux-en-Y吻合中吻合口张力过高问题的13例患者的临床资料,总结手术体会。结果吻合前空肠上提最大延长长度为(7.75±1.75)cm(4～10 cm),吻合后空肠上提实际延长长度为(5.95±1.82)cm(3～9 cm),延长长度实际使用率为(77.91±16.60)%(50.0%～100.0%)。术后发生急性尿储留1例,发生左肝下间隙脓肿、腹腔感染1例,无手术死亡或严重术后并发症如吻合口漏、吻合口狭窄、腹腔出血等病例。结论带血管弓单管空肠技术能够有效安全地延长空肠系膜长度,从而降低吻合口张力。该技术在临床实践中简便易行,在遇到吻合口有潜在张力风险时可考虑采用。
Objective To investigate the feasibility of anastomosis tension in esophageal-jejunal Roux-en-Y anastomosis after total gastrectomy with esophagogastric junction jejunum and esophagogastric junction jejunum. Methods Retrospective analysis of the Roux-en-Y Roux-en-Y after total gastrectomy was performed in our hospital from December 2012 to April 2013 with the treatment of esophageal-gastric adenocarcinoma and upper gastric cancer with bowed single- Anastomosis in the anastomotic hypertonic problems in 13 cases of clinical data, summary of surgical experience. Results The maximal extension length of jejunum before anastomosis was (7.75 ± 1.75) cm (4 ~ 10 cm). The average extension length of jejunum after anastomosis was (5.95 ± 1.82) cm (3 ~ 9 cm) (77.91 ± 16.60)% (50.0% ~ 100.0%). One case of acute urinary retention occurred after operation, with a left subhepatic space abscess and one case of abdominal infection. No operative death or severe postoperative complications such as anastomotic leakage, anastomotic stenosis and celiac hemorrhage were found. Conclusions Single bowel jejunum with vascular arch can effectively and safely prolong the length of jejunum mesangial and thus reduce the anastomotic tension. This technique is simple and straightforward in clinical practice and may be considered when there is a potential risk of tension in the anastomosis.