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.     

A Prospective Randomized Controlled Trial of Semi-mechanical versus Hand-sewn or Circular Stapled Esophagogastrostomy for Prevention of Anastomotic Stricture

Background

Successful anastomosis is essential in esophagogastrectomy, and the application of the circular stapler effectively reduces the anastomotic leakage, although stricture formation has become more frequent. The present study, a randomized controlled trial, compared the recently developed semi-mechanical anastomosis with a hand-sewn or circular stapled esophagogastrostomy in prevention of anastomotic stricture.

Methods

Between November 2007 and September 2008, 160 consecutive patients with esophageal carcinoma underwent surgical treatment our department. Five patients were excluded from this study, and the remaining 155 patients were completely randomized to receive either an everted plus side extension esophagogastrostomy (semi-mechanical [SM] group) or a conventional hand-sewn esophagogastric anastomosis ([HS] group) or a circular stapled ([CS] group) esophagogastric anastomosis, after dissection of the esophageal tumor and construction of a tubular stomach. The primary outcome was the incidence of an anastomotic stricture at 3 months after the operation (defined as the diameter of the anastomotic orifice ≤0.8 cm on esophagogram). Secondary outcomes were the dysphagia score and reflux score, as well as the anastomotic diameter.

Results

The anastomotic stricture rate was 0 % (0/45) in the SM group, 9.6 % (5/52) in the HS group, and 19.1 % (9/47) in the CS group (p < 0.001). The mean diameter of the anastomotic orifice was 18.2 ± 4.7 mm in the SM group, 11.5 ± 2.4 mm in the HS group, and 9.5 ± 3.0 mm in the CS group (p < 0.001). The reflux/regurgitation score among the three groups was similar.

Conclusions

Semi-mechanical esophagogastric anastomosis could prevent stricture formation more effectively than hand-sewn or circular stapler esophagogastrostomy, without increasing gastroesophageal reflux.     

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.     

Comparison of manual and mechanical cervical esophagogastric anastomosis after esophageal resection for squamous cell carcinoma: a prospective randomized controlled trial

Objective: The use of a circular stapler in cervical esophagogastric anastomosis remains controversial. This study was to compare the postoperative and long-term results of manual and mechanical techniques for cervical esophagogastric anastomosis after resection for squamous cell carcinoma. Methods: A prospective randomized controlled trial was undertaken in 63 patients with curatively resectable squamous cell cancer of the thoracic esophagus between 1996 and 1999. Patients were randomized to receive either a hand-sewn (32 patients) or circular stapled (31 patients) cervical esophagogastric anastomosis. Results: The mean operating time was longer when the hand-sewn method was used (524 vs. 447 min, P<0.001). Anastomotic leakage was noted in seven patients (22%) in the hand-sewn group and eight patients (26%) in the stapler group (P=NS). Hospital mortality occurred in four patients (13%) of the hand-sewn group and in three patients (10%) of the stapler group (P=NS). After the operation, four patients (14%) in the hand-sewn group and five patients (18%) in the stapler group developed a benign esophageal stricture (P=NS). The mean follow-up time was 24 months, and the rates of freedom from benign stricture and survival were comparable in each group. Conclusions: Performing cervical esophagogastric anastomoses using a circular mechanical stapler had a shorter operating time and a comparable outcome to the hand-sewn method. The circular mechanical stapler could be used as an alternative for cervical esophagogastric anastomosis after resection for esophageal squamous cell cancer.     

不同平面吻合加盖大网膜或下肺韧带预防食管、胃吻合口瘘及狭窄

目的改进食管胃吻合方式，降低吻合口瘘及狭窄的发生率。方法将５５２例食管、贲门癌患者随机分为３组，分别采用荷包式吻合；食管胃分层吻合；食管胃不同平面吻合，吻合口加盖大网膜或下肺韧带三种不同的吻合方式，比较各组吻合口瘘及狭窄的发生率。结果吻合口瘘发生率分别为：３．７５％，１．０９％和０；狭窄的发生率分别为：８．１％，３．２５％和０．９６％。三组结果有显著性差异。结论食管胃不同平面吻合，吻合口加盖大网膜或下肺韧带可有效预防食管胃吻合口瘘及狭窄的发生。     

Clinical Application of Mucosal Valve Technique for Anastomosis During Esophagogastrostomy

Background

The study aims to compare the efficacy in prevention of anastomotic complications using layer-to-layer mucosal valve technique versus circular stapled technique for esophagogastric intrathoracic anastomosis after resection for esophageal and gastric cardiac carcinoma.

Methods

From January 2005 to December 2010, 136 patients received layer-to-layer mucosal valve technique (LM group), 219 received circular stapled anastomosis (CS group) after curative intent resection for esophageal and gastric cardiac carcinoma. The technique details were reported and the clinical results were analyzed.

Results

The two groups were comparable on clinical baseline characteristics. The average duration of operation was longer with LM technique by 16 min, but without statistical significance (P?=?0.073). There was no anastomotic leakage in the LM group, while in the CS group, leakage occurred in seven patients (3.2 %, P?=?0.047). Both the incidence and grade of postoperative dysphagia were significantly lower in the LM group (P?<?0.05). Significantly fewer patients experienced stricture after LM technique (3.8 %) compared with CS anastomosis (18.2 %, P?<?0.001). CS anastomosis was associated with a significantly higher incidence of persistent stricture requiring more dilatation (P?<?0.001). Symptoms of reflux were better controlled by LM technique; 82.7 % of patients were asymptomatic with respect to reflux compared to 58.9 % in the CS group, P?<?0.001. And there was a significant reduction in the incidence of esophagitis in remnant esophagus in the LM group (P?=?0.001).

Conclusions

The layered mucosal valve anastomosis could significantly diminish the incidence of anastomotic complications and could be used as an alternative for esophagogastric anastomosis after resection of esophageal and gastric cardiac carcinoma.     

食管胃侧侧吻合预防吻合口狭窄的临床随机对照研究

目的 评价使用食管胃侧侧吻合术预防术后吻合口狭窄的效果.方法 2007年11月至2008年9月连续收治行食管癌、贲门癌切除术的患者160例,2例拒绝随机分组,3例不符合人选标准,其余155患者完全随机分组为食管胃侧侧吻合组、吻合器吻合组与手工吻合组,通过术后3个月食管造影测量吻合口直径确定吻合口狭窄的发生率(吻合口直径≤O.8 cm为吻合口狭窄).结果 术后死亡1例,行剖胸探查1例.术后并发吻合口漏4例(其中手工吻合3例,吻合器吻合1例).随访率为96.1%(失访6例,侧侧吻合组1例,手工吻合组3例,吻合器组2例).共144例患者进行了意向治疗分析(侧侧吻合组45例,手工吻合组52例,吻合器组47例).三组患者术前情况类似,侧侧吻合组术后吻合13狭窄率(0)低于手工吻合组(9.6%)及吻合器组(19.1%,Fisher 精确概率法,P=0.005),而三组之间的术后胃食管反流程度学差异无统计学意义(χ~2=1.681,P=0.432).结论 食管胃侧侧吻合术能够有效地预防吻合口狭窄,同时并不加重胃食管反流.     

应用消化道吻合器在食管胃颈部吻合的体会

１９８８年１０月至１９９５年２月应用消化道吻合器对１８８例食管癌切除后病人行颈部吻合，并以机械吻合方法代替传统手工操作。吻合无失败者。术后吻合口瘘发生率１６％（３／１８８），吻合口狭窄２１％（４／１８８）。无吻合口出血，无手术死亡病例。作者认为，颈部机械吻合方法操作简单，易于掌握，吻合可靠，缩短了手术时间，减少了术后并发症的发生。     

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.     

Mechanical cervical esophagogastric anastomosis after esophagectomy for cancer

AIM: Fibrous stenosis of the esophagogastric cervical anastomosis remains a significant complication occurring in up to one third of cases. Trying to reduce the incidence of this complication, we describe our technique of cervical esophago-gastric anastomosis using endoscopic linear stapler which seems to reduce the incidence of fibrous stricture formation after resection of esophageal cancer. METHODS: Between March 2000 and December 2004, 34 patients (20 males and 14 females) underwent esophagectomy using tubulized stomach for reconstruction. Mean age was 57 years. Eight patients with advanced stage (5 T3 and 3 T4) underwent induction chemotherapy. The most of patients was affected by squamous cell carcinoma. In all cases we performed cervical esophagogastric anastomosis using linear endoscopic stapler. The occurrence of postoperative anastomotic leak and development of anastomotic stricture were recorded and analyzed. RESULTS: All patients survived esophagectomy and 30 of them (88%) were available for postoperative follow-up at 6 months. Anastomotic leak developed in 1 case. No patient developed fibrous stenosis that required dilatation therapy. CONCLUSIONS: Complete mechanical esophago-gastric anastomosis, using endoscopic linear stapler is effective and safe, even when a narrow gastric tube is used as esophageal substitute. These technique seems superior to other techniques to reduce the incidence of postoperative anastomotic complications.     

Complete mechanical cervical anastomosis using a narrow gastric tube after esophagectomy for cancer.

OBJECTIVE: Fibrous stenosis of the esophagogastric cervical anastomosis remains a significant complication occurring in up to one-third of cases. Trying to reduce the incidence of this complication, we describe our technique of cervical esophagogastric anastomosis using endoscopic linear stapler which seems to reduce the incidence of fibrous stricture formation after resection of esophageal cancer. METHODS: Between March 2000 and June 2003, 26 patients (15 males and 11 females) underwent esophagectomy using tubulized stomach for reconstruction. Cervical esophagogastric anastomosis using linear endoscopic stapler was performed in all cases. The occurrence of post-operative anastomotic leak and development of anastomotic stricture were recorded and analyzed. RESULTS: All patients survived esophagectomy and were available for post-operative follow-up. Anastomotic leak developed in one case. No patient developed fibrous stenosis that required dilatation therapy. CONCLUSION: Complete mechanical esophagogastric anastomosis, using endoscopic linear stapler is effective and safe, even when a narrow gastric tube is used as esophageal substitute. This technique seems superior to other techniques to reduce the incidence of post-operative anastomotic complications.     

Comparison of hand-sewn and stapled esophagogastric anastomosis after esophageal resection for cancer: a prospective randomized controlled trial.

OBJECTIVE: The objective of this study was to compare the hand-sewn and stapled methods in esophagogastric anastomosis. SUMMARY BACKGROUND DATA: After esophageal resection for cancer, the relative merits of the hand-sewn and the stapled methods of esophagogastric anastomosis, especially regarding leakage and stricture rates, have not adequately been studied. METHODS: A prospective randomized controlled trial was undertaken in 122 patients with squamous cell cancer of the thoracic esophagus who underwent a Lewis-Tanner esophagectomy. Patients were stratified according to esophageal size, based on the diameter of the divided esophagus (< or > or = 30 mm) and then were randomized to have either a hand-sewn or a stapled anastomosis. RESULTS: The mean total operating times (standard error of the mean) when the hand-sewn and the stapled methods were used were 214 (4) minutes and 217 (3.4) minutes, respectively (p = not significant [NS]). The respective in vivo proximal resection margins (standard error of the mean) were 8 (0.4) cm and 7.6 (0.4) cm (p = NS). Leakage rates were 1.6% and 4.9% (p = NS). Excluding hospital deaths, patients with leakage or anastomotic recurrence, and those who received radiation therapy to histologically infiltrated resection margin, anastomotic stricture was found in 5 (9.1%) of 55 patients in the hand-sewn group and 20 (40%) of 50 in the stapler group (p = 0.0003). The difference in stricture rates was significant in small as well as large esophagi. Anastomotic recurrence developed in only one patient in each group. CONCLUSIONS: The authors conclude that both methods were safe, but the stapled technique resulted in more stricture formation.     

Double-stapled esophagogastric anastomosis for resection of esophagogastric or cardia cancer: new application for an old technique.

In colorectal surgery, the double-stapled technique is used extensively, because it is a fairly safe and simple procedure and is useful in relatively inaccessible areas. For these reasons, we adapted the procedure to the upper gastrointestinal tract. The present study reports our first experiences of the surgical efficacy using an esophagogastric double-stapled end-to-end anastomosis for subtotal esophagectomy and cardia resection. We retrospectively studied 31 patients treated between January 1991 and January 1997 with respect to hospital mortality, anastomotic leakage, cancer recurrence, and benign stricture rate. No hospital mortality was seen. One nonfatal anastomotic leak occurred (3%). In three patients, esophageal resection was not radical (10%). Of the remaining 28 patients, one had an anastomotic cancer recurrence (4%). Eleven of the remaining 27 patients (41%) developed a benign anastomotic stricture. All achieved normal swallowing after a median of two endoscopic dilatation procedures using TTS balloons. In conclusion, the double-stapled end-to-end anastomosis technique after resection for esophagogastric or cardia cancer is a simple and expeditious procedure, carrying an acceptable perioperative morbidity and cancer recurrence rate. Larger staplers are recommended to lower the high stricture rate observed after the usage of a 21-mm stapler in this study.     

112 例贲门癌两种吻合方法的比较研究

【摘要】 目的 探讨椭圆形手工吻合方法和传统的套入式式吻合方法在贲门癌手术中的应用价值。方法 回顾性分析2009年9月至2012年9月112例贲门癌患者手工圆形吻合和套入式吻合方法的资料。 结果 手工椭圆形吻合有1例吻合口漏和1例吻合口狭窄,吞咽顺利;有2例有轻度反酸;套入式吻合法有3例发生吻合口漏,有4例出现吻合口狭窄,则10例有胃食管返流(P<0.05),两组在手术时间和出血量无统计学差异(P>0.05)。结论 在贲门癌消化道重建中,手工椭圆形吻合法比套入式吻合法更能预防和减少吻合口漏和吻合口狭窄,并能预防返流性食管炎。     

Minimizing cervical esophageal anastomotic complications by a modified technique

BACKGROUND: The anastomotic leak and stricture formation after esophagectomy and cervical esophagogastric anastomosis deny patients with esophageal carcinoma the benefits of surgery. The present study was designed to ascertain whether a wide cross-sectional area at the site of anastomosis leads to lesser anastomotic complications. METHODS: One hundred patients with resectable carcinoma of the esophagus were randomly distributed into two groups of 50 each. All patients underwent one-stage transhiatal esophagectomy. In group A, 3 x 2 cm gastric crescent was excised from the anterior wall of the gastric tube before constructing the cervical esophagogastric anastomosis. No such intervention was done in group B, which acted as control. All patients were followed up for at least 3 months for detection of anastomotic complications. RESULTS: The incidence of anastomotic leak in the study group was significantly less in comparison with the control group (4.3% versus 20.8%; P = 0.03). Similarly, anastomotic stricture formation was significantly lower in the study group (8.5% versus 29.2%; P = 0.02). CONCLUSIONS: A wide cross-sectional area achieved at the anastomotic site by removal of gastric crescent resulted in significantly lower anastomotic complications.     

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。     

End-to-End Cervical Esophagogastric Anastomoses Are Associated with a Higher Number of Strictures Compared with End-to-Side Anastomoses

Background

Leakage and benign strictures occur frequently after esophagectomy. The objective of this study was to analyze the outcome of hand-sewn end-to-end versus end-to-side cervical esophagogastric anastomoses.

Methods

A series of 390 consecutive patients who underwent esophagectomy with gastric conduit reconstruction was analyzed.

Results

The end-to-end technique was performed in 112 (29 %) patients and the end-to-side in 278 (71 %) patients. Anastomotic leakage occurred in 20 (18 %) patients with an end-to-end anastomosis versus 58 (21 %) patients with an end-to-side anastomosis (p?=?0.50). A higher incidence in anastomotic strictures was seen in end-to-end anastomoses (48 (43 %)) compared with end-to-side anastomoses (89 (32 %); p?=?0.04). Moreover, a median of 11 (7–17) dilations was necessary in patients with a benign anastomotic stricture in the end-to-end group compared with four (2–8) dilations in patients with a benign anastomotic stricture in the end-to-end group (p?<?0.036). After multivariate analysis, the difference in anastomotic leakage rates remained nonsignificant (p?=?0.74), whereas anastomotic stricture rate and number of dilations were higher in the end-to-end group (p?=?0.03 and p?=?0.01, respectively).

Conclusion

The technique of anastomosis is not significantly related to anastomotic leakage rate. However, patients with end-to-end anastomoses develop postoperative strictures more frequently, requiring a higher number of dilations compared to end-to-side anastomoses.     

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.     

贲门癌根治术术中管状吻合器的使用优点及技巧探讨

目的 探讨贲门癌根治术(食管空肠吻合及残胃食管吻合)术中管状吻合器的使用优点及技巧.方法 1998年～2007年本院753例贲门癌根治术行食管空肠吻合或残胃食管吻合重建消化管,术中均使用一次性管状吻合器.结果 本组753例,无手术死亡,行胸腹联合手术6例(0.80%),无吻合口漏发生,吻合器切割不全2例(0.26%),发生吻合口狭窄4例(0.53%),腹腔感染1例(0.13%),膈疝1例(0.13%),术后标本病理检查上切缘癌累及1例,下切缘均未累及.结论 在贲门癌根治术中,管状吻合器的运用简化了手工操作程序,可靠、安全、省时,降低贲门癌进胸手术比例,手术创伤小,恢复快,能有效地预防吻合口瘘和狭窄.但吻合器吻合也不是绝对安全的,吻合口瘘、出血、狭窄等并发症仍有一定的发生率,术中技巧值得在今后的工作中进一步总结、探讨.