食管癌和贲门癌术后吻合口重度瘢痕狭窄的外科治疗

目的总结食管癌和贲门癌术后吻合口重度瘢痕狭窄外科治疗的经验。方法对24例重度吻合口瘢痕狭窄并下咽困难的患者行二次手术治疗。其中,原发肿瘤为食管癌17例(9例为颈部食管胃吻合,8例为胸内食管胃弓上吻合),贲门癌7例(6例为胸内食管胃弓下吻合,1例为经腹食管胃膈下吻合);狭窄段长0,3～0．5cm、在瘢痕基础上形成蹼状者18例,狭窄段长0．5～1．0cm、环形狭窄呈收缩状者6例。二次手术解剖吻合区的吻合口上下各1—2cm范围,在距吻合线上下各2～4mm处分别切开一半食管腔和胃腔,然后切除部分瘢痕狭窄环组织,再行食管-胃单层吻合。结果24例成功地完成二次手术,1例出现颈部吻合口瘘,无手术死亡。术后随诊2—3年,患者可顺利进软食和普食,未发生二次吻合口狭窄,生活质量明显提高。结论食管癌和贲门癌术后发生的吻合口重度瘢痕狭窄,可行二次手术切除部分瘢痕狭窄环再吻合,效果较好。

Surgical treatment of severe cicatricial anastomotic stricture after esophagectomy for esophageal and cardiac cancer

OBJECTIVE: To review the experience of the surgical procedure in the treatment of postoperative severe cicatricial anastomotic stricture for esophageal cancer and cardiac cancer. METHODS: Twenty-four cases with severe anastomotic strictures and dysphagia after esophagectomy underwent second operation. The anastomosis was opened by two small transverse incisions about 1-2 mm above and below the anastomotic line. The esophageal and gastric walls were half opened. Then the circular cicatricial tissue was partially removed. The re-anastomosis was performed with a one layer, intermittent technique. RESULTS: The second operations were successfully completed in 24 cases, cervical anastomotic leakage happened in 1 case and no operative mortality. All cases were followed up for 2-3 years. All patients can eat soft and common diet smoothly. No anastomotic strictures were found and the quality of life was significantly improved. CONCLUSION: The second surgery with partial removal of the narrow cicatricial ring and reanastomosis for postoperative severe anastomotic stricture after esophagectomy is feasible, and the result is satisfactory.