食管胃端端吻合在食管胃交界部癌切除术中的应用

目的:探讨食管胃端端吻合在食管胃交界部癌切除术中的临床应用价值。方法:48例食管胃交界部癌行常规近半胃切除及区域淋巴结清扫后,采用食管胃端端吻合重建消化道,并重点观察术后切缘癌残留率、吻合口瘘以及术后3个月胃肠功能,包括吻合口狭窄、胃食管反流、进食量、进食频率、胃排空情况及体重恢复情况。结果:本组48例患者手术均顺利完成,术后无切缘癌残留、吻合口瘘、胃排空障碍以及胸胃综合征等并发症的发生。术后3个月吻合口狭窄3例(6.3%),胃食管反流症状者13例(27.0%),进餐量与术前进餐量之比为(0.83±0.14)kg,每天进餐频率为(4.1±1.2)次,体重恢复到术前的患者占41.5%。结论:食管胃端端吻合在食管胃交界部癌切除手术中安全可行,能降低食管胃切缘癌残留的发生率和全胃切除的可能性,预防术后胃排空障碍,减小术后饭量损失,利于患者树立生活信心,改善术后生活质量,值得临床推广应用,特别适用于贲门肿瘤较大(胃体侵犯较多)和胃体较小者。

The application of esophagogastric end-to-end anastomosis in the resection of esophagogastric junction carcinoma

Objective：Assess the clinical application value of esophagogastric end-to-end anastomosis in the resection of espphagogastric junction carcinoma （EJC）. Methods ： 48 patients with EJC underwent the resection of nearly half of the stomach and dissected the lymphoid nodes as usual,and then received esophagogastric end-to-end anastomosis for reconstruction of the digestive tract. Postoperative residual tumor rate,anastomotic leakage, gastrointestinal functions in 3 months after operation including anastomotic stenosis, gastroesophaeal reflux disease, food intake, requency of eating, gastric emptying function and body weight recovery parameters were observed. Results： All 48 cases of operations were successful. No complication such as residual tumor,anastomotic leakage,delayed gastric emptying or thoracic stomach syndrome occurred after the operation. 3 months after the operation,anastomotic stricture occurred in 3 cases（6.3% ） ,and gastroesophaeal reflux occurred in 13 cases（27.0% ）. The average ratio of food intake rate before and after oper- ation was 0. 83 ± 0. 14,and the frequency of eating is （4. 1 ± 1.2）per day. The rate of the body weight recovering to the preoperative period was 41.5%. Conclusion： Esophagogastric end-to-end anastomosis is safe and feasible in the resection of EJC. It reduces the possibility of residual tumor and resection of the whole stomach. It also prevents delayed gastric emptying after the surgery and reduces the loss of eating. In this way,the patients can establish confidence in life and improve the quality of life. It＇ s worthy of clinical application,especially for the larger cardia tumor and smaller gastric body.