管状胃食管颈部分层吻合法在食管癌手术中的应用

目的 探讨食管癌病人用管状胃与食管在颈部分层吻合重建上消化道的应用价值. 方法 对我院2009-07～2012-02的184例食管癌病人的根治术中采用管状胃在颈部与食管黏膜对黏膜、肌层对肌层的分层吻合法,其中黏膜层采用4-0可吸收缝线连续缝合,肌层采用0号丝线间断缝合重建上消化道.中、下段食管癌病人采用经左胸、左颈两切口改良食管癌根治术,上段食管癌病人采用右胸、腹、左颈三切口食管癌根治术.对184例患者的资料进行回顾性分析,术后随访,重点探讨该术式在防止并发症方面的优势. 结果 本组184例病人中,颈部吻合口瘘4例,吻合口狭窄3例,吻合口出血1例,无胸胃综合征及胸胃漏发生,返流性食管炎症状明显改善,提高了病人的生活质量. 结论 分层吻合法能有效减少吻合口瘘和狭窄的发生;管状胃可以满足颈部吻合时所需胃的长度并可有效预防或减少胸胃综合征、返流性食管炎、胸胃漏等并发症的发生,术后对病人肺功能影响小,远期生活质量高.

Application of tubular stomach and cervical esophagus layered anastomosis in esophagectomy

Objective To explore the clinical value of tubular stomach and cervical esophagus anastomosis in esophagectomy.Methods Totally 184 patients with esophagectomy from July 2009 to February 2012 were performed tubular stomach and cervical esophagus layered anastomosis in mucosa（4-0 absorbable sutures） and muscular layer（0 silk）.The patients underwent the left chest and neck two-incision esophagectomy for the esophageal cancer in the medium and lower segment,and right chest,upper abdomen,left neck three-incision esophagectomy for the upper esophageal cancer.The clinical data of 184 patients were retrospectively analyzed to explore the advantages of the operation to prevent complications.Results Of 184 cases,4 cases encountered cervical anastomotic fistula,3 cases of anastomotic stenosis,and one case of anastomotic bleeding.No thoracic stomach syndrome and thoracic gastric fistula occurred.Besides,the reflux esophageal inflammation symptoms were obviously improved.Conclusion Layered anastomosis could effectively reduce the occurrence of anastomotic fistula and stenosis.Tubular stomach could provide the required length of the stomach to effectively prevent and reduce the chest syndrome,reflux esophagitis,the incidence of leakage of thoracic stomach,and the influence on the lung function after the operation,and thus improve the long-term quality of life.