C(S)DH圆型吻合器在食管癌和贲门癌手术中的应用

目的：评价C（S）DH圆型吻合器在食管癌和贲门癌手术中的优缺点。方法：1996年1月至2000年1月,我科采用该吻合器进行了600例食管、贰门癌切除及胸内或颈部吻合术,其中食管癌410例,贲门癌190例,颈部吻合33例,胸顶吻合20例,弓上吻合357例,弓下吻合190例。结果：600例中无器械故障发生,颈部吻合口瘘1例,术后出现吻合口狭窄11例,结论：通过与另外两种常用的国产吻合器进行比较,作者认为C（S）DH型形吻合器在上消化道重建手术中操作方便,安全可靠。     

经食管床食管胃弓上器械吻合治疗食管癌

目的总结食管癌切除手术中应用吻合器行经食管床食管胃弓上器械吻合的临床经验.方法全组食管癌46例,其中食管胸中段癌32例,胸下段癌11例,胸上段癌3例.全部经左胸后外侧切口行食管癌切除,术中采用国产WGW-Ⅱ型消化道吻合器,行经食管床食管胃弓上吻合.结果全组手术吻合顺利,无术后死亡、吻合口瘘及明显吻合口狭窄.结论经食管床食管胃弓上器械吻合治疗食管癌具有扩大切除范围、降低术后并发症的优点,值得推广.     

应用管状吻合器行食管胃胸内吻合发生吻合口瘘的原因分析

我科自1984年4月～1995年12月,共应用管状消化道吻合器(以下简称吻合器)行食管胃胸内吻合724例,术后发生吻合口瘘19例(2.6%).现将其发生的原因分析如下:1 临床资料本组19例均为食管癌贲门癌患者,男性15例,女性4例;年龄54岁～71岁.中段食管癌左侧剖胸食管胃弓上吻合发生吻合口瘘者11例(2例为第一次弓下吻合失败),右侧剖胸剖腹食管胃右胸内吻合发生3例;下段食管癌贲门癌左侧剖胸弓下吻合发生5例.吻合口瘘发生时间为术后2日～17日.死亡率为36.8%(7/19),其中因吻合口主动脉瘘死亡者2例.     

吻合器在食管癌和贲门癌切除术的应用

报告我院自1982年2月至1987年底应用吻合器治疗食管癌和贲门癌207例的临床经验.其中食管癌171例,贲门癌34例,食管双原位癌2例;弓下吻合58例,弓上吻合122例,胸膜顶吻合27例.并发症发生率为16.4%,吻合口瘘发生率为2.4%,吻合口狭窄发生率为5.8%,手术死亡率为2.4%.本文还讨论了吻合口瘘和狭窄的发生原因和提高吻合技术的重要性.     

食管贲门癌切除器械吻合术926例

目的:总结食管、贲门癌切除后应用器械吻合防止吻合口瘘和狭窄的临床经验。方法:回顾性分析926例食管贲门癌患者应用吻合器治疗的结果。结果:发生并发症28例(3%),包括吻合口狭窄20例(2.2%),吻合口出血8例(0.8%),无吻合口瘘,无手术死亡及住院死亡。结论:器械吻合完整快捷,明显减少手术操作时间和吻合口并发症的发生。     

食管癌手术两种吻合法对吻合口并发症的影响

目的:通过对比分析,进一步认识吻合器在食管癌手术中对于降低吻合口并发症的重要作用.方法:对758例食管中下段癌以及贲门癌患者,分别用两种吻合方法,观察两组吻合口并发症的发生率.其中手工吻合组548例;吻合器吻合组210例.结果:手工吻合组吻合口漏的发生率为2.92%,吻合器吻合组吻合口漏发生率为0;手工吻合组吻合口狭窄发生率为6.39%,吻合器吻合组吻合口漏发生率为0.48%.结论:吻合器吻合法能有效降低吻合口并发症,值得推广.     

前外侧开胸治疗食管下段癌及贲门癌的体会

目的探讨食管下段癌、贲门癌手术切口进路,改进食管胃吻合方法及部位.方法我院1996年～1998年对45例食管下段癌及贲门癌患者采用左前外侧开胸,借助吻合器将食道胃置于主动脉弓后吻合.结果根治性切除20例,姑息性切除25例,手术时间2.5～4小时,术中无大出血,平均输血400ml,术后病理检查腺癌28例,鳞状上皮癌17例,切缘均为阴性,淋巴结清扫结果有癌转移(83/225).术后左下肺感染3例,无吻合口瘘,全组无手术死亡.结论本术式与其他术式相比较具有以下优点①手术创伤相对较小,操作简单,并发症少.②采用吻合器将食管胃吻合在弓后,吻合口针距严密均匀,且有良好血供,加之弓后间隙固定、通畅,周围组织容易粘连,避免吻合口瘘发生.③适当缩胃并将其置于食管床内,对肺无压迫,对心肺功能欠佳的病例更为适用.④可满足贲门癌、食管下段癌根治的手术要求.     

Gambee一层吻合法的应用及改进

近年来食管癌、贲门癌切除后行食管胃吻合术，虽然吻合方法有许多创新和改进，但是术后吻合口疼和狭窄仍难以杜绝。我院1988年1月～1996年12月行食管责门癌切除食管胃吻合196例，其中一层吻合法45例（Gambee法38例），二层吻合法32例和吻合器法119例。一层吻合法术后未发生并发症，H层吻合法和吻合器法各发生1例吻合口疼和吻合口狭窄。临床资料本组行Gambee吻合法38例中，男性28例，女性10例，年龄43～80岁。其中食管上段癌2例，中段癌20例，下段癌10例和责门癌6例。食管胃吻合术在颈部吻合6例，弓上吻合22例，弓下吻合10例。水后病理诊断…     

经食管床弓上机械吻合术治疗食管癌

目的探讨利用GF-1型吻合器行食管癌手术的胸内最佳吻合术式.方法对86例食管胸中下段癌采用GF-1型吻合器经食管床行食管-胃主动脉弓上吻合术,并对术后相关并发症加以总结.结果86例患者术后48～72小时离床活动者占96.5%,心律失常发生率为3.5%,平均胸腔引流量为280ml,均于术后6～7天进流食,10天进半流食,15天进软食,术后未出现吻合口瘘和肺不张.结论利用GF-1型吻合器经食管床行弓上吻合较以往普遍采用的弓旁弓上胸内吻合操作复杂,但因其符合正常人体的解剖和生理,可减少或避免很多术后并发症,是值得推广应用的一种机械吻合术式.     

应用吻合器治疗上段食管癌13例

13例上段食管癌切除后经食管床上提胃到颈部,用CDH-25型吻合器完成食管胃吻合术.13例病人使用吻合器行颈部吻合均获成功,全组上切线均未见癌残留,无吻合口瘘,吻合口狭窄1例,喉返神经损伤1例,反流性食管炎2例,无手术死亡,手术效果良好.     

管状吻合器在食管癌颈部吻合中的改进及应用体会

背景与目的：食管癌颈部吻合与胸内吻合相比能减少术后并发症,但吻合151瘘和吻合口狭窄仍是食管癌颈部吻合的主要并发症,而吻合器则能有效减少此术后并发症。本研究改进了管状吻合器在食管癌颈部吻合的操作步骤并评价其临床疗效。方法：对2006年10月至2008年4月127例食管癌患者行食管癌根治术。胃代食管置入食管床,改进了管状吻合器在颈部的操作步骤并进行食管胃器械吻合。分析术后并发症发生情况。结果：全部患者无手术死亡及吻合口出血,吻合口瘘1例（0．8％）,吻合口狭窄5例（3．9％）,经扩张后好转。结论：改进后的管状吻合器颈部吻合技术安全有效,可降低术后吻合口并发症。     

胸内食管胃端侧器械吻合1 555例的经验和体会

目的：总结胸下段食管癌或贲门癌切除术后胸内食管胃端侧器械吻合的经验和体会方法：对1990年1月至2005年6月间行胸下段食管癌或贲门癌切除食管胃端侧器械吻合术共1555例做回顾性分析结果：手术平均耗时2小时40分钟，术后吻合口少量出血24例、吻合口瘘16例、吻合口狭窄32例、胃食管返流110例，发生率分别为1.54％、1．03％、2．06％和7．07％，术后3个月内发生吻合口胸主动脉瘘9例（0．58％），其中手术止血成功4例，死亡5例结论：应用管状消化道吻合器行胸内食管胃端侧吻合术效果可靠，操作方便，易于掌握，值得推广应用，但仍有一定比例的并发症发生，尤其是吻合口胸主动脉瘘，应引起重视     

A novel modification of double stapling technique in Billroth I anastomosis

Although the double‐stapling technique has been used as a safe procedure in gastroduodenostomy, creating anastomosis with a circular stapler on the linear stapler line can be vulnerable for anastomotic leakage and ischemia. Therefore, we tried to modify the double‐stapling technique to avoid stapling on the staple line. J. Surg. Oncol. 2009;100:518–519. © 2009 Wiley‐Liss, Inc.     

双吻合器技术在直肠癌保肛手术中吻合口瘘的危险因素分析

背景与目的：直肠癌术后吻合口瘘是严重的并发症之一,降低吻合口瘘发生率是临床亟待进一步解决的问题,本研究探讨使用双吻合器进行直肠前切除术(Dixon术)后吻合口瘘的发生及原因分析。方法：回顾性分析150例使用双吻合器进行直肠前切除术的患者,对术后发生吻合口瘘的患者进行性别、年龄、身体质量指数(body mass index,BMI)、细胞分化程度、吻合口部位、TNM分期、是否合并糖尿病、是否合并术前贫血及是否进行术前新辅助放疗的单因素分析,旨在进一步判断直肠前切除术后吻合口瘘的风险。结果：150例患者中共7例发生吻合口瘘,其中3例行二次手术回肠造瘘,4例保守治疗后愈合。单因素分析及多因素分析证实,吻合口距肛距离、术前新辅助放疗是影响直肠癌术后吻合口瘘的独立危险因素。结论：使用双吻合器技术进行直肠前切除的吻合其术后吻合口瘘发生率相对较低,吻合口距肛距离、术前新辅助放疗是影响直肠癌术后吻合口瘘的独立危险因素,对于吻合口瘘的高危患者可以考虑选择性的进行保护性小肠造口。     

Laparoscopic side-to-side esophagogastrostomy using a linear stapler after proximal gastrectomy

In order to improve anastomotic procedures, we performed laparoscopic side-to-side esophagogastrostomy, using a linear stapler, after proximal gastrectomy in two patients with gastric cancer located in the upper third of the stomach. The patients' postoperative courses were excellent. During postoperative recovery, the patients experienced very little pain, used no analgesic medications, and never experienced reflux esophagitis. This procedure is technically feasible and is an excellent option, given the less involved anastomotic procedure and better postoperative quality of life compared with these features in end-to-side anastomosis using a circular stapler. Received: February 2, 2001 / Accepted: April 24, 2001     

国产KYGWA型一次性吻合器在贲门胃底癌中的应用

目的探讨国产KYGWA型一次性吻合器在贲门胃底癌中的应用。方法统计1998年1月至2008年5月实行根治或姑息性手术的贲门胃底癌患者593例,其中应用吻合器217例（吻合器组）,未用吻合器376例（手工组）。对两组的开胸率、吻合口瘘、肺部及胸腔感染、吻合口狭窄、近断端癌残留等方面的资料进行回顾性对比分析。结果吻合器组开胸率为21．66％,手工组为72．87％,吻合器组开胸率明显低于手工组,差异有统计学意义（P〈0．05）。吻合器组吻合口狭窄发生率4．15％,手工组20．74％,两组比较差异有统计学意义（P〈0．05）。两组在吻合口瘘、肺部及胸腔感染和近断端癌残留方面的差异无统计学意义。结论在贲门胃底癌切除术中利用国产一次性吻合器行消化道重建可以减少开胸率和吻合口狭窄发生率,且该吻合器价格低廉,具有临床应用价值,尤其适合经济欠发达地区医院的使用。     

Safety of EEA staplers for anastomosis between upper esophagus and the gastric tube

The EEA stapling devices used for intrathoracic anastomosis between the upper esophagus and the gastric tube in patients with carcinoma of the thoracic esophagus were evaluated, and the results were compared with those of an antesternally reconstructed esophagus. These approaches were both used by the same surgical team. An intrathoracic anastomosis using the EEA stapler was made in 53 patients with carcinoma of the thoracic esophagus. Minor anastomotic leakage occurred in five patients (9.4%). Good results were obtained with total parenteral nutrition for 2 weeks. Intrathoracic anastomotic complications were never fatal. Among another 106 patients with antesternally reconstructed esophagus, with the EEA stapler there were 28 patients with anastomotic leakage (26.4%) and two operative mortalities (1.9%). Intrathoracic anastomosis with the EEA stapler is recommended because it is secure and the operative procedure is simple and time-saving. For successful use of the instrument, proper technical procedures must be followed.     

The comparisons of three stapler placement methods for intrathoracic mechanistic circular stapling in Ivor Lewis minimally invasive esophagectomy

BackgroundTo analyze the impact of the reversal penetrating technique (RPT) for intrathoracic gastroesophageal mechanical anastomosis on the development of anastomotic complications in Ivor Lewis minimally invasive esophagectomy (ILMIE), and to further identify the risk factors for the development of anastomotic leakage and stricture.MethodsA retrospective observational study was conducted using the clinical data of 316 patients with esophageal carcinoma (EC) who underwent ILMIE from January 2012 to December 2019. The participants were divided into three groups, namely the RPT group, the transoral Orvil technique (TOT) group, and the purse-string technique (PST) group, according to the different stapler placement methods for intrathoracic mechanistic circular stapling. Multivariate analysis was performed to investigate the association of risk factors with anastomotic leakage and stricture.ResultsThere were 154 patients in the RPT group, 78 in the TOT group, and 84 in the PST group for intrathoracic gastroesophageal circular stapling in ILMIE. There were no differences in intraoperative anastomosis-related conditions including conversion of open operations, and lymph nodes harvested between the three groups. However, the mean total operative time and gastroesophageal anastomosis time in the RPT group were significantly shorter than those in the other groups (both P<0.05). The rates of anastomotic leakage and stricture showed no statistical differences between the three groups (leakage: P=0.875; stricture: P=0.942). Multivariate analysis revealed that the RPT method of anvil placement did not increase the probability of anastomotic leakage [RPT: reference; TOT: odds ratio (OR) 0.422, P=0.341; PST: OR 1.436, P=0.645] and stricture (RPT: reference; TOT: OR 0.579, P=0.376; PST: OR 1.195, P=0.755).ConclusionsThe RPT method of anvil placement for intrathoracic gastroesophageal circular stapling does not increase the risk of anastomotic complications in ILMIE, but had significantly shorter surgical time and anastomosis time.