消化道吻合器在颈部胃食管吻合中的应用

目的 总结食管癌切除后采用消化道吻合器行颈部胃食管吻合术治疗食管癌患者的临床经验,以降低术后吻合口瘘和吻合口狭窄的发生率,提高手术疗效.方法 125例食管癌患者,根据采用的手术术式不同分为两组,器械吻合组:行食管癌切除后采用国产常州WGWB-26型吻合器进行颈部胃食管吻合;手工吻合组,行食管癌切除后采用手工方法进行颈部胃食管吻合.比较两种手术术式的胃食管吻合时间、术后吻合口瘘和吻合口狭窄的发生率.结果 全组无手术死亡.器械吻合组吻合时间少于手工吻合组(30±5min vs.55±5 min, P＜0.05),近期吻合口瘘和吻合口狭窄发生率明显低于手工吻合组(0% vs.4.8%, 0% vs.9.5%,P＜0.05);器械吻合组随访1～15个月食管X线钡餐检查证实无吻合口狭窄.结论 使用吻合器行胃食管器械吻合,能增加吻合的可靠性,减少术后并发症,包括吻合口瘘和吻合口狭窄的发生.     

食管癌切除术颈部机械吻合与手工吻合的疗效分析

目的 评价机械吻合与手工吻合在食管癌切除术颈部吻合中的应用价值.方法 本研究回顾性分析2010年1月至2012年1月四川省肿瘤医院收治的187例食管癌患者的临床资料,根据行食管癌切除术后颈部吻合的方式不同分为机械吻合组(98例)和手工吻合组(89例),比较两组患者吻合时间、总手术时间、术后开始进食时间、住院时间、术后并发症发生率及食管残端癌阳性率的差异,计量资料采用t检验,计数资料采用x2检验或Fisher确切概率法.结果 机械吻合组患者吻合时间、总手术时间、术后开始进食时间及住院时间分别为(7.8±1.4)min、(227±60) min、(6.3±0.9)d、(14±4)d,短于手工吻合组的(28.5±2.3) min、(301±81) min、(8.4±1.0)d、(22±9)d,两组比较,差异有统计学意义(t=75.44,7.14,7.71,7.41,P＜0.05);机械吻合组患者术后吻合口瘘发生率为1％ (1/98),低于手工吻合组的8％(7/89),两组比较,差异有统计学意义(P＜0.05);两组吻合口狭窄发生率分别为5％ (5/98)和7％ (6/89),两组比较,差异无统计学意义(P＞0.05);机械吻合组无食管残端癌,手工吻合组食管残端癌阳性率为4％(4/89),两组比较,差异有统计学意义(P＜0.05).结论 机械吻合在食管癌颈部吻合中不仅能缩短吻合时间、总手术时间及住院时间,而且能降低吻合口瘘发生率和食管残端癌阳性率.     

颈部管状胃、食管器械吻合在中上段食管癌手术中的运用

目的总结中上段食管癌手术经验,探讨管状胃、颈部器械吻合在中上段食管癌手术中的运用。方法纳人襄阳市一医院心胸外科2010年1月至2013年3月手术治疗的中、上段食管癌患者122例,根据重建消化道手术方式不同分两组：管状胃器械吻合组68例,男38例、女30例,年龄（63．5±11．2）岁;左胸径路、食管肿瘤切除后,胃管状成形由食管床提至左颈部,采用国产管状吻合器行胃、食管吻合;全胃手工吻合组54例,男32例、女22例,年龄（62．6±10．7）岁;左胸径路、食管肿瘤切除后,全胃由食管床提至左颈部与近端食管行手工单层、宽边吻合。比较两种手术方式下患者的临床效果。结果全组无手术死亡。管状胃器械吻合组在游离后胃的长度明显长于全胃手工吻合组（t=10．60,P=0．000）,吻合时间（t=32．92,P=-0．000）、总手术时间（t=-5．75,P=-0．000）及平均住院时间（t=9．58,P=0．000）较全胃手工吻合组缩短,吻合口瘘（χ^2=4．75,P=-0．029）、吻合口狭窄（χ^2=6．01,P=0．014）、呼吸循环并发症（χ^2=5．34,P=-0．021）发生率较全胃手工吻合组低,而两组乳糜胸发生率差异无统计学意义（χ^2=5．34,P=0．753）。结论在中上段食管癌手术中,胃管状成形并颈部器械吻合能有效降低术后并发症的发生,是较为理想的消化道重建方法。     

食管胃套接术与器械吻合术治疗食管、贲门癌的对比研究

目的对比食管胃套接术与器械吻合术的临床治疗效果,以减少食管、贲门癌根治术后并发症的发生率. 方法将285例诊断明确的食管、贲门癌住院患者按入院顺序随机分为两组,食管胃套接组(套接组)134例,采用食管癌切除食管瓣片成形-食管胃套接术;器械吻合组(吻合组)151例,采用食管癌切除器械吻合术.术后观察吻合口瘘、吻合口狭窄和胃食管反流并发症的发生率,并随访观察3年. 结果套接组术后吻合口瘘、吻合口狭窄和胃食管反流的发生率分别为0%、2.2%和1.5%,而吻合组为1.3%、13.9%和21.2%(P<0.01). 结论食管瓣片成形-食管胃套接术术后并发症少、操作简单,较器械吻合具有一定的优越性.     

食管癌切除胃食管颈部吻合与胸腔内吻合的对比分析

目的比较食管癌切除胃食管颈部吻合与胸腔内吻合的手术疗效。方法中下段食管癌患者165例,根据手术方式不同,将其分为两组,胃食管颈部吻合组:73例,经左颈、右胸、上腹正中三切口手术40例,经左胸、左颈二切口手术33例。胸腔内吻合组:92例,经左胸或右胸径路行主动脉弓上吻合47例,弓下吻合45例。比较两组术后并发症的发生率和生存率。结果术后食管胃颈部吻合组残端癌、手术死亡率和吻合口瘘死亡率均低于胸腔内吻合组(P<0.05);两组患者间5年生存率差别无统计学意义(P>0.05);但淋巴结转移阴性和阳性患者5年生存率两组间比较差别均有统计学意义(P<0.05)。结论食管癌切除胃食管颈部吻合术治疗中下段食管癌符合肿瘤根治原则,肿瘤切除彻底,残端癌的发生率和死亡率低。     

吻合口胃侧荷包缝合在食管胃胸内器械吻合术中的应用

目的 探讨吻合口胃侧荷包缝合在食管胃胸内器械吻合术中的安全性和有效性.方法 回顾性分析2008年1月至2011年12月四川省人民医院收治的行食管胃胸内器械吻合术治疗的238例胸段食管癌和24例食管胃结合部癌患者的临床资料,其中122例吻合口按常规方法处理(常规组),140例改进了处理方法,吻合前在吻合口胃侧吻合器中心杆处予以1号丝线作浆肌层荷包缝合并结扎(改进组),比较两组患者吻合口瘘和吻合口狭窄发生率等临床指标.计量资料比较采用￡检验,计数资料比较采用x2检验或者Fisher确切概率法.结果 两组患者手术时间、术中出血量、术后24 h胸腔积液引流量、术后住院时间和术后pTNM分期比较,差异无统计学意义(t=0.410,0.798,0.634,0.362,x2=0.605,P＞0.05);两组患者吻合器使用类型、吻合口位置、吻合器食管端组织质量比较,差异无统计学意义(x2 =0.118,0.221,t=0.459,P＞0.05);两组患者术后肺部并发症、心律失常等并发症的发生率以及病死率比较,差异无统计学意义(P＞0.05);但改进组吻合器胃端组织质量大于常规组,差异有统计学意义(t=13.856,P＜0.05);改进组术后吻合口瘘、吻合口狭窄的发生率均低于常规组,差异有统计学意义(P＜0.05).结论 吻合口胃侧荷包缝合操作简单、安全,不延长手术时间和住院时间,可以有效减少食管胃胸内器械吻合术后吻合口瘘和吻合口狭窄的发生.     

食管癌患者食管-管状胃环形吻合器端侧吻合与半器械侧侧吻合近期治疗效果观察

目的观察食管癌患者食管-管状胃环形吻合器端侧吻合与半器械侧侧吻合术后近期治疗效果。方法回顾性分析66例手术治疗食管癌患者的临床资料。30例采用食管-管状胃颈部半器械侧侧吻合术,36例采用食管-管状胃胸内环形吻合器端侧吻合术,比较两种吻合术后近期吻合口瘘、吻合口狭窄、反流性食管炎的发生率。结果半器械侧侧吻合术食管狭窄和反流性食管炎的发生率分别为3.3%(1/30例)和20.0%(6/30例),均低于环形吻合器吻合术的25.0%(9/36例)和61.1%(22/36例),两组比较差异有统计学意义(P0.05);半器械侧侧吻合和环形吻合器吻合术后吻合口狭窄发生率分别为3.3%(1/30例)和5.6%(2/36例),两组比较差异无统计学意义(P0.05)。结论食管一管状胃半器械侧侧吻合与形吻合器端侧吻合比较,术后近期吻合口狭窄及反流性食管炎发生率较低。     

全腔镜食管癌三野根治术颈部机械吻合与手工吻合的应用比较

目的：评估全腔镜食管癌三野根治术食管胃颈部吻合方式（机械或手工）对术后吻合口相关并发症发生的影响。方法回顾性分析2010年1月至2013年11月间在福建省肿瘤医院胸外科接受全腔镜食管癌三野根治术治疗的203例食管癌患者的临床资料。根据颈部吻合方式的不同,分为机械吻合组（104例）和手工吻合组（99例）。比较两组患者术后吻合口相关并发症发生率。结果机械吻合组术中吻合时间较手工吻合组明显缩短[（15．5±5．0） min比（28．0±4．5） min,P＜0．01]。两组术后吻合口瘘发生率分别为5．8％（6/104）和3．0％（3/99）,差异无统计学意义（P＞0．05）;吻合口狭窄发生率分别为9．6％（10/104）和2．0％（2/99）,差异有统计学意义（P＜0．05）。结论与手工吻合相比,全腔镜食管癌三野根治术食管胃颈部机械吻合操作简单、吻合确切,但吻合口狭窄的风险增加,因此,在临床实践中,应结合患者的具体情况合理选择吻合方式。     

机械吻合与食管胃分层吻合术治疗食管和贲门癌的对比研究

目的比较机械吻合术与分层吻合术在预防食管和贲门癌手术后吻合口瘘、吻合口狭窄和食管反流并发症发生率的差异。方法将316例食管和贲门癌患者按入院顺序随机分为机械吻合组(162例,采用食管癌切除机械吻合术)和分层吻合组(154例,采用食管癌切除食管胃分层吻合术)。分别比较两组术后吻合口瘘、吻合口狭窄和食管反流并发症发生率。结果机械吻合组术后吻合口瘘和吻合口狭窄发生率分别为1.2%和2.0%,而分层吻合组则分别为3.9%和4.7%,两组比较P<0.01。两组胃食管反流的发生率(88.8%、89.3%)差异无统计学意义(P>0.05)。结论对于预防食管和贲门癌手术后吻合口瘘、吻合口狭窄方面,机械吻合优于分层吻合法。     

食管癌切除术后不同重建途径吻合口瘘的原因及预防

目的了解食管癌切除术后经不同径路重建,发生吻合口瘘的情况;探讨系统性淋巴结清扫后,经胸骨后胃代食管颈部吻合口瘘发生率较高的原因及预防方法。方法1105例行食管癌切除术的患者,229例经左胸行胸内吻合(A组),716例经右胸食管床胃代食管行颈部吻合(B组),160例予以系统性淋巴结清扫术后经胸骨后行颈部吻合(C组)。分析比较不同手术径路的3组患者术后吻合口瘘发生的情况。结果吻合口瘘发生率分别为:A组5/229(2.2%)、B组85/716(11.9%)、C组31/160(19.4%),C组吻合口瘘发生率显著高于A、B组(P<0.01和P<0.05)。比较C组不同重建方式吻合口瘘发生率显示,手工吻合与器械吻合(22.2%与11.6%,P=0.133)、全胃重建与管状胃重建(25%与15.6%,P=0.146)间吻合口瘘发生率无明显差异,而延长胃肠减压管留置时间至术后7d,吻合口瘘发生率由23.3%降至9.1%(P<0.05)。结论胸骨后胃代食管吻合口瘘发生率较高的主要原因,是前纵隔内的胃体受压、冲击吻合口所致;通过延长胃肠减压管留置时间能有效减少瘘的发生。     

食管粘膜层经隧道食管胃吻合术的临床研究

目的食管癌手术后吻合口瘘和吻合口狭窄的并发症已明显下降,而反流性食管炎已成为影响术后患者生活质量的主要并发症。为此设计了食管粘膜层经胃壁肌层下隧道行食管胃吻合术。方法食管粘膜层经隧道食管胃吻合术１７５例,其中２０例与同期隧道式食管胃吻合术２０例进行对比研究。术后６～１２个月,行食管压力测定、食管镜检查、组织活检和食管内反流液ｐＨ值测定。结果２组患者术后均无吻合口瘘发生,无手术死亡。结论该术式具有明显地抗反流作用,可预防反流性食管炎的发生     

兜底式食管胃吻合术的临床应用研究

摘要：目的评价兜底式食管胃吻合术对吻合口瘘、吻合口狭窄和胃食管反流的预防作用及效果,探讨蒙特利尔定义“胃食管反流病”诊断流程、标准在食管重建术后的实用价值和意义。方法回顾性分析2007年6月至2011年6月笔者医院采用两种术式共行食管癌和贲门癌切除1078例的临床资料,参考相关诊断标准制表,问卷调查两组患者术后吻合VI狭窄和胃食管反流的发病情况。试验组（兜底式食管胃吻合术）582例,男403例、女179例,年龄（60．4±12．6）岁。食管癌399例,贲门癌183例,弓上吻合392例,弓下吻合190例。对照组（传统食管胃端侧吻合术）496例,男343例、女153例,年龄（59．2±12．8）岁。食管癌322例,贲门癌174例,弓上吻合317例,弓下吻合179例。结果与传统食管胃端侧吻合术相比,兜底式吻合术后吻合VI瘘的发生率较低[0％（0／582）VS．1．0％（5／496）,x2=5．835,P=O．016）];胃食管反流症状亦较轻,而伴有食管外症状及需要服用制酸剂患者则更少[1．6％（33／541）VS．12．6％（57／453）,矿=23．564,P=O．000],术后吻合口狭窄率各为0．9％（5／539）和7．3％（34／465）（x2=25．124,P=O．000）,尤其是重度吻合I=I狭窄的发生率更低[0％（0／539）VS．4．7％（22／465）,X2=24．883,P=O．000]。两组5年生存率差异无统计学意义。结论兜底式吻合法在预防食管胃吻合VI瘘、吻合VI狭窄和胃食管反流的发生方面较传统术式为优;蒙特利尔定义胃食管反流诊断流程和标准适合于食管重建术后胃食管反流之诊断。     

贲门癌切除术中机械与手工吻合疗效比较及评价

目的:探讨贲门癌切除术中可靠有效的吻合方法,以提高临床疗效。方法:回顾性分析以手工吻合技术完成的110例(手工吻合组)和采用管状吻合器完成的180例(机械吻合组)贲门癌手术后患者临床资料,比较两组出现的与吻合技术有关的并发症情况。结果:两组手术时间,吻合口出血发生率无统计学差异(均P>0.05);机械吻合组的吻合口瘘、吻合口狭窄、反流、声嘶发生率及术后6个月病死率均低于手工吻合组(均P<0.05);两组间3年生存率无统计学差异(P>0.05)。结论:机械吻合法在减少术后并发症及病死率方面优于手工吻合法,且操作简单、疗效可靠。     

Clinical Application of Layered Anastomosis During Esophagogastrostomy

The aim of this study was to compare the operative results in regard to reducing anastomotic leakage and stricture formation using a newly designed layered manual esophagogastric anastomosis versus a stapler esophagogastrostomy versus the conventional hand-sewn whole-layer anastomosis after resection for esophageal or gastric cardiac carcinoma. From January 2004 to September 2006, a total of 1024 patients with esophageal or gastric cardia carcinoma underwent a layered esophagogastric anastomosis with the assistance of a three-leaf clipper in a single university medical center. The mucosal layers of the esophagus and stomach were sutured continuously with 4/0 Vicryl plus antibacterial suture (polyglyconate). From May 2002 to December 2003, there were also 170 patients and 69 patients who underwent stapler and conventional whole-layer anastomosis, respectively; they served as control groups. The results were analyzed retrospectively. The operative mortality rate was 0.7% in the layered group compared to 5.9% and 7.2% for the stapler group and the whole-layer group (p < 0.01), The anastomotic leakage rates were 0%, 3.5%, and 5.8% for the layered group, stapler group, and whole-layer group, respectively (p < 0.01). All patients were followed postoperatively. Six patients in the layered group (0.6%) developed mild stricture formation compared to 16 patients in stapled group (9.9%) and 5 patients in the conventional whole-layer group (7.8%) (p < 0.01). The application of layered esophagogastric anastomosis could reduce the incidence of anastomotic leakage and stricture after esophagectomy compared with the stapler and whole-layer manual anastomoses. It is easy to apply and could be used as an alternative for esophagogastric anastomosis after resection for esophageal or cardiac carcinoma. This abstract was accepted as a free paper and oral presentation at International Surgical Week 2007, Abstract 320, Montreal, Canada, August 2007     

胃浆肌瓣包套的食管胃吻合术

目的 探讨预防食管,贲门癌手术后吻合口瘘和狭窄,返流性食管炎发生的方法。方法 对２７３例贲门癌,食管下段癌患者,随机分为治疗组１４５例,对照组１２８例,并分别采用胃浆肌瓣包套的食管胃吻合术及传统的食管胃二层同心圆吻合术。结果 治疗组无吻合口瘘及吻合口狭窄,返流性食管炎１０例。     

Embedded Cervical Esophagogastrostomy: A Simple and Convenient Method Using a Circular Stapler After Esophagectomy for Esophageal Carcinomas

Background

Cervical esophagogastrostomy is currently the most common method for esophageal reconstruction after esophagectomy. The advantages and disadvantages of hand-sewn, linear-stapled, or circular-stapled anastomoses have been subject to debate in recent years. We explored a new method of end-to-side anastomosis using a circular stapler that embeds the anastomosis and the remaining esophageal tissue into the gastric cavity to reduce the occurrence of anastomotic leakage and to prevent gastroesophageal reflux.

Methods

In 127 patients with esophageal carcinomas, end-to-side anastomoses with esophageal embedding were performed by connecting the anvil and body of the circular stapler inside the stomach before firing and embedding the anastomosis and remaining esophagus into the stomach after esophagectomy. Retrospective investigations on postoperative complications such as leakage, stricture, and gastroesophageal reflux were conducted.

Results

A total of 123 patients (96.9 %) had successful surgery, and 4 patients (3.3 %) developed anastomotic leakage, with the total morbidity of 20 of 123 (16.3 %) and in-hospital mortality of 1 of 123 (0.8 %). The incidence of stricture (<1 cm) affected 14 of 123 patients (11.4 %). Eight patients underwent dilatation treatment as a result of severe dysphagia (6.5 %). Half of the patients [62 of 123 (50.4 %)] experienced postoperative heartburn, 11 of 123 patients (8.9 %) experienced acid regurgitation, and 16 of 123 patients (13.0 %) experienced nocturnal cough.

Conclusions

Embedded cervical esophagogastrostomy with circular stapler is a simple and convenient method, with low incidence of anastomotic leakage and a good antireflux effect.     

Cervical esophagogastric anastomosis with a new stapler in the surgery of esophageal carcinoma.

OBJECTIVE: A new reusable circular stapler for cervical esophagogastric anastomosis (CEGA) has been used to substitute the traditional method of hand-sewn cervical anastomosis. METHODS: Over a 2-year period (09/1998-11/2000), the stapler was engaged on operations of 112 patients with thoracic esophageal carcinoma, and the anastomosis was performed through both cervical and thoracic incision. The operative approaches were through left thoracotomy in 85 cases, and through right thoracotomy in 27 cases. The results were analyzed retrospectively. RESULTS: All of the 112 CEGA operations were successfully performed on the patients who underwent esophageal resections, and no operative mortality and anastomotic leakage occurred. Excluding the two patients with the anastomotic recurrent carcinoma, anastomotic stricture occurred in 12 cases (10.9%, n=110). Median time to the presentation of anastomotic stricture was 4.3 months (range 2.6-25.3 months), and the median number of dilatations was 3 (range 1-5). When divided into the 24 and 26 mm groups, the respective incidences of stricture were 12.3 (7/57) and 9.4% (5/53), respectively, and the statistical results of the two sizes of staplers were essentially the same (P=0.6691). Eight patients experienced nonanastomotic-related complications (7.3%, n=110), in which there were three cases of recurrent laryngeal nerve injury, four cases of the left side pneumothorax, and one case of perforation of the proximal stomach. There was also a case of stapling gauze at anastomosis. Some of the complications were closely related to the initially improper use of the new stapler's craft. CONCLUSIONS: The results indicate that CEGA using the new circular stapling device in surgery of the esophageal carcinoma is a very effective procedure to improve the anastomotic technique from a traditional hand-sewn anastomosis to a stapled anastomosis and can reduce the incidence of complications.     

Esophagogastric anastomosis performed with a stapler: the occurrence of leakage and stricture

The circular stapler has lowered the leakage rate of an esophageal anastomosis to a level hitherto achieved by only a few surgeons performing hand anastomosis on selected patients with carcinoma of the esophagus. However, the esophageal anastomosis performed with a stapler is also associated with a high stricture rate. Our prospective study was conducted to determine the leakage rate and the incidence of stricture after esophagogastric anastomosis was performed with a stapler, the relationship of stricture to the size of the stapler, and the risk of stricture in relation to time. In a group of 174 patients with carcinoma of the thoracic esophagus, resection was performed, and a one-stage esophagogastric anastomosis was constructed. There were 33 hand anastomoses, 64 anastomoses with an EEA stapler (U.S. Surgical Corp., Norwalk, Conn.), and 77 anastomoses with an ILS stapler (Ethicon Ltd., Edinburgh, U.K.). The anastomotic leakage rate was 3.4% (6/174); 3% with the hand technique and 3.5% with the stapler technique (4.7% for the EEA and 2.6% for the ILS). After leakages and hospital deaths were excluded, 133 discharged patients were evaluated for the occurrence of anastomotic strictures. Only those who complained of dysphagia were investigated. The incidence of stricture for hand anastomosis was 8.7%-EEA 20% and ILS 10%; the overall incidence of anastomoses with a stapler was 14.5%. The true incidence would probably be higher if all patients were assessed by endoscopic or radiologic examination after operation. All three sizes of EEA staplers had a high incidence of stricture. For the ILS stapler the 25 mm size had the highest stricture rate (28.6%) of all groups, but for the 29 and 33 mm sizes, the incidences were 5.3% and 0%, respectively. Actuarial analysis showed an increasing risk of stricture with a reduction in the size of stapler used and was 32.5% and 35%, respectively, for the ILS 25 mm and EEA 25 mm staplers at 131/2 months. The risk of stricture occurrence was highest in the first 4 months. Treatment by bougienage was satisfactory. In conclusion, esophagogastric anastomosis performed with a stapler is a very safe procedure with respect to leakage but is associated with a high risk of stricture, except when the largest ILS staplers are used. However, dilatation readily overcomes the stricture occurrence and adequately compensates for the reduced leakage rate and its attendant serious consequences.     

食管癌切除后食管胃颈部侧-侧吻合的近期疗效

目的 评价食管癌切除后食管胃颈部侧-侧吻合的近期疗效.方法 回顾性分析2006年1月至2009年3月第三军医大学大坪医院野战外科研究所收治的105例接受手术治疗的食管癌患者的临床资料.全组患者在全麻下行食管癌切除术,其中97例行食管胃颈部侧-侧吻合,8例行食管胃颈部手工端-端吻合.从行食管胃颈部侧-侧吻合的患者中选取9例与行食管胃颈部手工端-端吻合的患者进行比较,采用t检验分析两种吻合方式的术后咽食管功能.结果 97例行食管胃颈部侧-侧吻合的患者无手术死亡,吻合时间为15～30 min,平均为(21±3)min.16例患者术后出现并发症,其中肺部并发症7例,经抗感染和对症支持治疗后痊愈;声带麻痹4例,其中2例于术后3个月内恢复,2例为喉返神经损伤所致永久性声带麻痹,但无需进一步处理;吻合口漏3例,经更换敷料痊愈;吻合口狭窄2例,经扩张1～2次痊愈.术后咽食管功能:行食管胃颈部侧-侧吻合患者的吻合口直径为(3.01±0.17)cm,而行食管胃颈部手工端-端吻合患者为(1.69±0.26)cm,两者比较,差异有统计学意义(t=2.093,P＜0.05);2例行食管胃颈郎侧-侧吻合及4例行食管胃颈部手工端-端吻合的患者主诉有吞咽困难.结论 食管胃颈部侧-侧吻合是简单、安全、有效的吻合方法,吻合区的功能明显优于食管胃颈郎手工端-端吻合.