经胃黏膜下层食管胃黏膜单层吻合的愈合实验观察与临床应用

目的通过临床和动物实验,观察经胃黏膜下层食管胃黏膜单层吻合的吻合口愈合质量及其临床应用效果。方法采用本法施行食管癌、贲门癌手术305例患者;另将30只实验猪随机分成两组:①实验组(A组)15只,采用本法吻合;②对照组(B组)15只,采用单层吻合。比较两组术后吻合口的大体、组织学观察、血管内皮生长因子(VEGF)表达水平以及术中、术后的吻合口直径。结果①临床病例术后无一例早期死亡和发生吻合口瘘,有2例发生吻合口狭窄。②A组和B组比较,吻合口黏膜对合好、愈合早、瘢痕薄,VEGF表达水平合理。术后25 d,A组吻合口直径大于B组。结论经胃黏膜下层食管胃黏膜单层吻合法吻合口愈合质量高,能降低吻合口瘘和吻合口狭窄的发生。

Clinical application and experimental study on healing quality of stoma in transgastrosubmucosa gastroesophageal mucosa-mucosa anastomosis with vitiligo

Objective To summarize the clinical application of transgastrosubmucosa gastroesophageal mucosa-mucosa anastomosis and to observe the healing quality of anastomotic stoma in animal experiments.Methods Three hundred and five patients suffered from carcinoma of esophagus and carcinoma of gastric cardia had undergone esophagogastrostomy by transgastrosubmucosa gastroesophageal mucosa-mucosa anastomosis.Thirty experimental pigs were divided into two groups.The 15 pigs(group A) underwent transgastrosubmucosa gastroesophageal mucosa-mucosa anastomosis,while another 15 pigs(group B) underwent the intermittent whole-layer anastomosis with silk.In comparison with these two groups,VEGF of the anastomosis was detected,observed by general and histologic study on postoperative day(POD).Measuring diameter of anastomosis was made in operation and postoperation.These parameters of two group pigs were compared and analyzed.Results Among all the 305 patients in the study,none of anastomotic leakage and no perioperative death occurred.There were only two cases of stenosis.In comparison with group B,the stoma mucosa was in a better cooperation,a thin scar and a more rational expression of VEGF in group A.The diameter of stoma in group A was larger than that in group B.Conclusion The esophagogastrostomy by transgastrosubmucosa gastroesophageal mucosa-mucosa anastomosis has a high healing quality,decreasing the occurrence of anastomosis leakage and anastomotic stricture.