"种植式"食管胃吻合术

目的 为了预防食管癌、贲门癌手术后吻合口瘘、胃液食管反流、吻合口狭窄等吻合口相关并发症，设计“种植式”食管胃吻合术，总结其临床经验。方法 将196例食管、贲门癌患者分为两组，实验组：116例切开胃壁浆肌层与食管下端等宽，游离黏膜及黏膜下层形成指套状凸起，在其顶部切口与食管下端吻合，最后把浆肌层切缘上提缝合至食管外膜包埋吻合口；对照组：80例采用常规单层食管胃吻合术。术后14天、1、3、6和12个月分别对两组患者进行上消化道X线钡餐造影或纤维胃镜检查。结果 实验组无吻合口瘘发生，发生吻合口狭窄1例，胃液食管反流4例；对照组发生吻合口瘘3例，吻合口狭窄3例，不同程度胃液食管反流60例。结论 “种植式”食管胃吻合术是一种具有预防吻合口瘘、吻合口狭窄和较好的抗胃液食管反流作用，且符合生理的食管胃吻合术。     

食管瓣片成形——食管胃套接术的临床应用

目的 探讨消除食管胃吻合术后吻合口瘘、吻合口狭窄及胃反注等手术方法。方法 食管两侧纵行剪开１．５ｃｍ,形成二叶瓣片。胃前壁造口为套接口,将二叶瓣片经胃套接口确保完全置入腔内。不缝粘膜层,仅将食管肌层与胃壁浆肌层做双层间断缝合,二层间距为３ｃｍ,以食管胃套接术代替食管胃吻合术。结果 临床应用１７６例,无手术死亡,无吻合口瘘,无吻合口狭窄及胃反流,效果满意。结论 （１）缝合粘膜层是食管胃吻合术后发生吻     

间置空肠肌黏膜瓣成形在贲门癌术后抗反流中的应用

目的寻找一种能有效对抗贲门癌术后反流性食管炎的消化道重建术式. 方法将62例贲门癌患者分为两组,实验组30例,贲门癌手术采用间置空肠附加肌黏膜瓣成形消化道重建;对照组32例,采用"常规"食管-残胃套叠吻合.应用同位素测定胃食管反流指数,24小时食管pH监测及临床反流症状评定方法进行对比分析. 结果同位素胃食管反流指数测定显示,实验组反流阳性率为0%,对照组为93.33%.24小时食管pH测定显示,实验组Demeester评分为2.01±2.21,对照组为103.40±91.35,两组比较差别具有显著性意义(P<0.01).反流临床症状评定结果实验组无1例出现反流症状,而对照组24例(75%)出现反流症状. 结论间置空肠肌黏膜瓣成形术式具有优异的抗反流功效,能有效地防止贲门癌术后反流性食管炎的发生.     

食管胃黏膜活瓣式吻合术在食管下段癌、贲门癌切除中的应用

目的 探讨食管下段癌、贲门癌切除后食管胃黏膜活瓣式吻合术的方法及临床体会.方法 肿瘤切除及淋巴结清扫后消化道重建时,剥除食管肌层及胃浆肌层,使黏膜延长3～4 cm,然后食管黏膜与胃黏膜分层吻合,浆肌层包埋,包埋后吻合口置入胃腔内2-3 cm,切除胃超过2/3以上时辅以大网膜包绕吻合口.结果 施行该吻合方法38例,均恢复顺利,近期并发症3例,其中心律失常1例,肺部感染1例,乳糜胸1例,均经保守治疗全部治愈,随访半年后均可顺利进普通饮食,无吻合口狭窄及反流性食管炎表现.结论 食管胃黏膜活瓣式吻合术可有效地预防吻合口漏、狭窄、反流等并发症.     

食管-胃单层斜面宽边吻合232例

自 1993年 2月～ 2 0 0 1年 3月 ,我院在食管、贲门癌切除食管重建术中采用食管 -胃单层斜面宽边吻合 2 32例 ,无吻合口瘘和狭窄发生 ,临床效果满意。1　临床资料与方法1.1　一般资料　本组共 2 32例 ,男 16 0例 ,女 72例 ;年龄37～ 76岁 ,平均年龄 6 1.2岁。食管癌 182例 ,其中上段 2 1例 ,中段 96例 ,下段 6 5例 ;贲门癌 5 0例。行胸内吻合 115例 ,颈部吻合 117例 ,均经原食管床行食管 -胃吻合。1.2　手术方法　常规切除肿瘤 ,用心耳钳夹住食管断端上方约 2 .0～ 2 .5 cm处 ,将食管断端修剪成斜行向下约 30～ 35°的坡面 ,使食管黏膜比肌…     

食管重建中食管胃吻合术式的改进（附65例分析）

在65例食管癌、贲门癌手术治疗中,对吻合口的处理采用食管胃“两定点吻合”加半边大网膜覆盖。作为术式改进组;另对50例食管癌,贲门癌采用传统吻合方式,将肌层行间断缝合包埋,作为对照组。两组患者在性别,年龄、病灶的病理分类等方面无明显差异。比较两组的吻合口瘘和吻合口狭窄的发生率,术式改进组未发生吻合口瘘和吻合口狭窄;对照组发生吻合口瘘1例。发生吻合口狭窄4例。食管重建中,对吻合口的操作采用食管胃“两定点吻合法”能有效地避免和减少吻合口瘘及吻合口狭窄的发生。     

改良Gambee吻合法在食管-胃吻合术中的应用

目的探讨食管肿瘤、贲门癌行肿瘤切除后，以胃重建食管时食管-胃吻合技术的改进，预防吻合口瘘及狭窄的发生。方法采用Gambee单层吻合法及全层间断单层吻合法交替应用。结果采用此方法吻合的286例患者，吻合口瘘发生率2．7％（4／146）。吻合口瘢痕狭窄0．7％。束出现胸腔内吻合口瘘及近期吻合口狭窄。结论此法适用于食管-胃吻合术，特别适用于贲门癌胃切除较多的弓下食管-胃吻合术及食管癌切除食管-胃颈部吻合术。迄今，在广泛应用吻合器的情况下。手法缝合食管、胃吻合仍是外科医生必须熟练掌握的基本功，本文介绍的改良Gambee吻合法有推广应用价值。     

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。     

食管胃分层吻合法的应用与实验观察

目的通过临床和动物实验观察食管胃分层吻合法的临床应用结果及吻合口愈合质量。方法采用食管胃分层吻合法施行食管癌、贲门癌手术1024例,同期用该手术方法做动物实验并观察吻合口情况。将24只犬采用抽签法分成两组,实验组:12只,采用食管胃分层吻合法;对照组:12只,采用传统吻合方法作为对照。分别在术后5d、8d、14d和42d测量两组大体标本的吻合口口径、瘢痕长度、瘢痕厚度,组织学观察炎性细胞数、成纤维细胞数和毛细血管数,并进行表皮生长因子(EGF)和转化生长因子β1(TGF-beta1)的免疫组织化学实验(LsAB法)。结果临床结果:术后分别随访至3个月,1024例患者术后无吻合口瘘发生,仅6例发生轻度狭窄,经扩张一次缓解。实验结果:实验组黏膜对合良好、吻合口柔软、瘢痕薄,术后早期炎性细胞数和成纤维细胞数增多(P<0.05),术后第42d炎性细胞数和成纤维细胞数减少(P<0.05);对照组吻合口瘢痕厚、黏膜对合不齐、常有肌层暴露,早期炎性细胞数和成纤维细胞数较少,而术后8～14d明显增加,一直持续到术后42d仍有增加的趋势。实验组细胞因子早期活跃,高表达,至术后42d时仅有少量表达;而对照组早期表达低,术后第8d明显增加,第42d仍有较高表达。结论食管胃分层吻合法患者吻合口愈合质量高、瘢痕小,其细胞增生和生长因子的表达有利于伤口正常愈合且达到了一期愈合的标准,值得临床推广应用。     

黏膜缝合法在食管胃吻合中的应用体会（附52例报告）

1999年4月～2004年6月，笔者对52例食管癌患者，在食管部分切除后，用黏膜缝合法加肌层套叠吻合进行消化道重建，在预防吻合口瘘、吻合口狭窄、食管反流方面取得了理想的效果。现将体会报告如下。     

A safer and more reliable operative technique for esophageal reconstruction using a gastric tube

A safer and more reliable method of esophageal reconstruction, using a gastric tube, is described. The procedure to create an elongated gastric tube involves separate cutting of the seromuscular and mucosal layer along the line extending parallel to and 4 cm from the greater curvature of the stomach. The end of the cervical esophagus is anastomosed to the posterior wall of the gastric tube in end-to-side fashion. In addition, circumferential cutting of the seromuscular layer of the gastric tube about 5 cm from the anastomotic line is performed to avoid tension resulting from postoperative shrinkage of the gastric tube due to muscle contraction. Combination of these methods resulted in complete elimination of anastomotic leakage.     

Resection of esophageal and gastric cardiac cancer and esophagogastrostomy by planting esophagus into the stomach: a report of cases

105 cases of esophageal cancer and 46 cases of gastric cardia carcinoma were resected and the continuity of alimentary canal was resumed by planting esophagus into the stomach. This procedure had been designed by authors. There is neither anastomotic leakage nor stricture. Only 1 case died perioperatively. The anastomosis start by suturing the whole thickness of esophageal wall to the mucous membrane of stomach. Then the esophageal stump was telescoped into the stomach by suturing the secomuscular layer of stomach to the outer layer of esophageal muscles, with a distance of about 3 cm from the inner anastomatic line. When the anastomasis was finished, esophageal mucous membrane everted slightly, and prolapsed a little as food bolus passes. We suggest these are the mechanisms preventing the anastomosis from leaking or narrowing. Reflex of gastric content may be prevented too.     

A case of spontaneous rupture of the esophagus

Spontaneous rupture of the esophagus is rare. It's initial symptoms are so varied that we often have a hard time for making early diagnosis of esophageal rupture. In this case, emergency surgery was performed immediately after early diagnosis by chest CT. When the left thoracotomy was done, the upper portion of the stomach protruded with it's mucous membrane was reflected outward into the thoracic cavity above the diaphragm. When the reflected stomach was drawn back into the abdominal cavity for replacement, a ruptured wound of about 5 cm was observed on the left wall of the esophagus above the diaphragm. The stomach was seen protruded from this ruptured wound of the esophagus, with the mucous membrane reflected outward. No pathological abnormalities of esophagus itself was detected even after through investigation to search the cause for this clinically manifested weakness of the esophageal wall which eventually ruptured causing protrusion of the upper portion of the stomach into the thoracic cavity. The mechanism of this gastric protrusion is difficult to define. The most informative diagnostic investigation was the chest CT.     

微胆漏在胆管吻合口狭窄中的作用

目的 观察微胆漏在胆管吻合口狭窄病理过程中的作用.方法 将斑马猜24头随机分成3组.假手术组(S组),模拟吻合在胆管扎孔2圈,每圈8孔.对照组(C组),游离胆管20mm,切除约5 mm,行端端吻合,T型管引流.治疗组(T组),依C组方式手术,在吻合口以远置Forley导尿管(8号)至吻合口上15 mm引流胆汁,气囊注水阻断胆汁流经吻合口.分析各组微胆漏、术部瘢痕增生、吻合口内径及与其近端胆管内径比值.结果 S组与C组处理部位均有瘢痕增生,管壁厚度分别为(1.5±0.2)、(1.6±0.3)mm,但差异无统计学意义(P＞0.05).T组管壁厚度为(0.9±0.2)mm,与前两组比较差异均有统计学意义(P＜0.05);T组微胆漏明显少于S组及C组,3组引流液胆红素含苗分别为(36.8±5.4)、(141.9±17.7)、(107.5±11.6)μmol/L,T组较S组及C组差异均有统计学意义(P＜0.05).结论 吻合口微胆漏是吻合口瘢痕增生狭窄的重要原因之一,设法消除胆汁刺激可以改善吻合口瘢痕增生.     

CDH园型吻合器在胃底贲门癌外科中的应用

目的:评价CDH圆形吻合器经腹食管、胃吻合中的应用。方法:用该吻合器对45例胃底贲门癌切除术后行食管胃机械吻合,对照组同期18例胃底贲门癌切除术后行手工吻合,复习1989～1994年58例胃底贲门癌切除用上海GF-1型园型吻合器行食管胃机械吻合。结果:45例用CDH圆形吻合器均一次吻合成功,无器械故障,无吻合口瘘,无吻合口狭窄,无手术死亡病例。结论:CDH圆形吻合器设计合理、安全可靠、在胃底贲门癌经腹行食管胃吻合术中应用,可缩短手术时间,减少手术创伤,降低手术难度。     

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.     

Experimental study of healing process of anastomosis after "tunnel" esophagogastrostomy

The "Tunnel" esophagogastrostromy has been clinically proven to be effective in reducing the postoperative anastomotic leakage. An experimental study was carried out in 28 dogs to compare the healing process of "Tunnel" esophagogastrostomy (group A) and end-to-side anastomosis (group B), aiming at finding out the mechanism of prevention of anastomotic leakage after "Tunnel" esophagogastrostomy. The results showed that the mucosa of the esophagus and the stomach had fused at the site of the anastomosis on the fifth day in group A and the same processes had completed on the seventh day in group B. The blood supply of "Tunnel" anastomosis is better than that of the conventional end-to-side anastomosis, hence the hastening of the healing process. The protecting barrier formed with the gastric seromuscular in the "Tunnel" anastomosis plays an important role in preventing the occurrence of postoperative anastomostic leakage.     

Seromuscular gastrocystoplasty in dogs

INTRODUCTION: The aim of this study was to investigate the feasibility of seromuscular gastrocystoplasty (SGCP) in an animal model and to compare it to conventional gastrocystoplasty (CGCP). MATERIALS AND METHODS: CGCP and SGCP (using gastric segments without mucosa) were each performed in 6 dogs. In both procedures, two-thirds of the dome of the bladder were excised and the gastric segment anastomosed to the bladder remnant. Cystography, cystomanometry, measurements of urine pH, and gross and microscopic pathological studies were carried out preoperatively, and postoperatively, at 6 and 12 weeks. RESULTS: All seromuscular gastric segments proved viable, and 6 weeks after the operation they were covered by a thin layer of transitional epithelium, which had gradually thickened by the end of the 12-week follow-up. There was no difference in bladder capacity and compliance between the two groups, however, fasting urinary pH values were higher (less acidic) in the SGCP group. CONCLUSIONS: Stripping off the mucosa of the gastric segment appears to stop hydrochloric acid secretion, thereby lessening the possible risk of ulceration, perforation, dysuria-haematuria, metaplasia and malignancy. The uroepithelium overgrowth of the seromuscular gastric segments might provide a more physiological neo-bladder than when using full-thickness gastrocystoplasty.