改良吻合器吻合法经腹全胃切除预防吻合口瘘

目的探讨吻合器经腹全胃切除时预防吻合口瘘的方法.方法采用不设标志线、美蓝检查法及体位切口改进三项措施,改进全胃切除时吻合器吻合方法,观察了原方法组41例患者及改进方法组78例患者.同时采用离体猪肠管160段观察了原方法和改进方法各吻合40次结果.结果原方法吻合离体猪肠管40次,出现吻合口瘘5次,瘘口均有2个钉子松脱;改进方法40次无吻合口瘘发生(P＜0.05).临床上采用原方法吻合41例,2例患者出现吻合口瘘后死亡,膈下脓肿4例;改进方法78例患者中无吻合瘘发生、无膈下脓肿、无手术死亡,与原方法组比较P＜0.01.结论采用原吻合方法时留置标志线拉脱吻合钉是导致吻合口瘘的主要原因.改进后的吻合方法可以预防吻合口瘘的发生.

Prevention of anastomotic fistula by an improved stapler anastomosis in total gastrectomy through abdomen

Objective To evaluate the therapeutic effect of an improved stapler anastomosis on prevention of anastolrotic fistula in total gastrectomy through abdomen. Methods Three measures (without mark line, methylene blue examination and improved posture and incision) were taken to improve the original method by Griffen Jr. W O. The therapeutic effect of 41 cases of original method and 78 cases of improved method were observed; meanwhile, 160 pieces of isolated pig intestine received 40 times of original and improved method, respectively observed as well. Results In 40 times of isolated pig intestinal anastomosis by original method, 5 anastomotic fistulas were presented because of two loose nails in every anastomosis; but by improved method, no fistula was found (P < 0. 05). Of 41 cases receiving original method, 2 cases died of post-operative anastomotic fistula, 4 cases had subphrenic abscess. of 78 cases by improved method, none presented anastomotic fistula, subphrenic abscess and death (P<0. 01). Conclusion Setting up the mark line and pulling out stapler nails in the original method is the main cause of fistula. The improved method demonstrates that fistula at anastomosis can be effectively prevented.