颈部食管胃半套入斜形吻合术

目的:改进手术方法,减少食管癌术后吻合口瘘、吻合口狭窄,返流性食管炎等并发症。方法:对571例食管癌病人行食管次全切除,残食管与胃颈部吻合,吻合面呈斜形,吻合口后唇套入胃腔3cm对2001年3月～2001年10月来院复诊的所有食管癌术后病人(包括颈部半套入斜形吻合55例,颈部单层吻合38例,弓上袖状吻合42例),进行胃镜检查和食管腔内PH值测定。结果:术后共发生吻合口瘘4例,轻度吻合口狭窄17例;所有病人都能平卧睡眠,7例病人述后半夜于左侧卧位时出现返流症状,25例头低位造影轻度钡剂返流。胃镜检查和食管腔PH值测定结果,颈部半套入斜形吻合明显好于颈部单层吻合和弓上袖状吻合。结论:颈部食管胃半套入斜形吻合,能有效减少食管癌术后吻合口瘘,吻合门狭窄和胃液返流等严重并发症、提高术后生存率和患者术后的生存质量。

OBLIQUE ESOPHAGOGASTRIC ANASTOMOSIS WITH HALF INVAGINATION STYLE IN THE NECK

Objective: Improving operative method to decrease complications such as postoperative anastomosis fistula, stenosis and gastroesophageal reflux. Methods: 571 patients with esophageal cancer underwent subtotal esophagoectomy ,in which the remaining esophagus was anastomosed with the stomach in neck, with anastomosis rear lip invaginated into gastric cavity to 3cm and with a oblique anastomotic surface. From March,2000 to October, 2000,all the patients who came back to the hospital for a check .including 55 patients with oblique invagination anastomosis,38 patients with single- layer anastomosis in the neck,42 patients with sleeve anastomosis above arch of aorta, were given gastricoscopy and PH value determination in esophageal cavity. Results: After operation ,4 patients had anastomosis fistula, and 17 patients had light anastomosis stenosis. All the patients could go to sleep lying horizontly,7 patients presented reflux symptom in the midnight when lying to the left and 25 patients had barium reflux when esophagogram was performed with the head in low position. Through gastricoscopy and PH value determination in esophageal cavity, the results showed that the effect of oblique invagination anastomosis was significantly better than that of the other two methods. Conclusions: Oblique invagination anastomosis in neck for esophageal carcinoma can effectively decrease postoperative complications such as anastomosis fistula, stenosis and gastroesophageal reflux and improve survival rate and the quality of life.