管状吻合器在食管癌颈部吻合中的改进及应用体会

背景与目的：食管癌颈部吻合与胸内吻合相比能减少术后并发症，但吻合151瘘和吻合口狭窄仍是食管癌颈部吻合的主要并发症，而吻合器则能有效减少此术后并发症。本研究改进了管状吻合器在食管癌颈部吻合的操作步骤并评价其临床疗效。方法：对2006年10月至2008年4月127例食管癌患者行食管癌根治术。胃代食管置入食管床，改进了管状吻合器在颈部的操作步骤并进行食管胃器械吻合。分析术后并发症发生情况。结果：全部患者无手术死亡及吻合口出血，吻合口瘘1例（0．8％），吻合口狭窄5例（3．9％），经扩张后好转。结论：改进后的管状吻合器颈部吻合技术安全有效，可降低术后吻合口并发症。

Modified application of circular stapler to cervical esophagogastric anastomosis after esophagectomy for esophageal cancer

Background and Objective. Anastomotic leakage and fibrous stenosis are significant complications of the cervical esophagogastric anastomosis although cervical esophagogastric anastomosis appears to decrease morbidity as compared with intrathoracic anastomosis. We modified the techniques of cervical esophagogastric anastomosis using circular stapler after resection of esophageal carcinoma, and evaluated its efficacy. Methods： Between October 2006 and April 2008, 127 patients underwent esophagectomy using gastric tissues positioned in the original esophageal bed as esophageal substitute for reconstruction. Cervical esophagogastric anastomosis using circular stapler was performed in all patients. The occurrence of postoperative complications was recorded and analyzed. Results. No operation-related death and no anastomotic hemorrhage occurred. Anastomotic leakage developed in one patient （0.8%） because of instrumental failure; five patients （3.9%） developed fibrous stenosis that required stricture dilation. Conclusion： Modified mechanical cervical esophagogastric anastomosis using circular stapler is effective and safe, and can reduce the occurrence of postoperative anastomotic complications.