食管-管状胃颈部全机械侧侧吻合术60例

目的探讨食管-管状胃颈部全机械侧侧吻合术的临床应用价值及意义。方法回顾性分析2010年6月至2012年6月解放军153中心医院采用食管-管状胃颈部全机械侧侧吻合术行食管癌切除60例患者的临床资料,其中男41例、女19例,年龄46～78（64.2±6.4）岁,体重（58.6±12.6）kg;病变位于食管胸中段39例,胸下段15例,胸上段6例;食管癌TNM分期Ⅰ期1例,Ⅱ期32例,Ⅲ期23例,Ⅳ期4例。术后6～12个月对所有患者的饮食质量和胃食管反流情况进行问卷调查,其中52例复查时行上消化道X线钡餐造影,38例行胃镜及食管黏膜病理学检查。结果 60例患者全部治愈出院,住院时间（12.0±2.6）d,吻合时间（18.4±3.2）min,并发症的发生率为11.7%（7/60）,吻合口瘘的发生率为1.7%（1/60）,问卷调查60例患者术后恢复普通饮食,伴有胃食管反流症状者占23.3%（14/60）。X线钡餐造影检测吻合口径为1.2～2.2（1.6±0.2）cm,头低脚高45°观察发现59.6%（31/52）的患者显示钡剂向食管反流,未见钡剂潴留、胸胃扩张及胃排空障碍等;胃镜检查发现63.2%（24/38）的患者显示吻合口完全开放,36.8%（14/38）的患者呈不规则闭合或半闭合状态,食管黏膜病理检查发现18.4%（7/38）的患者为慢性炎性病变。结论食管-管状胃全机械侧侧吻合术对预防食管癌切除术后吻合口狭窄、吻合口瘘、胸胃综合征有良好效果,值得推广应用。

Complete Mechanical Cervical Side-to-side Esophago-gastric Tube Anastomosis in 60 Patients

Objective To explore clinical outcomes of complete mechanical cervical side-to-side esophago-gastric tube anastomosis. Methods Clinical data of 60 patients with esophageal carcinoma （EC） who underwent complete mechanical cervical side-to-side esophago-gastric tube anastomosis in the 153rd Central Hospital of People＇s Liberation Army from June 2010 to June 2012 were retrospectively analyzed. There were 41 male and 19 female patients with their age of 46-78 （64.2±6.4）years and body weight of 58.6±12.6 kg. There were 39 patients with mid-thoracic EC, 15 patients with lower-thoracic EC, and 6 patients with upper-thoracic EC. There was 1 patient with stage I EC, 32 patients with stage lI EC, 23 patients with stage III EC, and 4 patients with stage 1V EC. Six to 12 months after the operation, all the patients re- ceipted a survey questionnaire regarding their quantity and quality of food intake as well as gastroesophagea reflux （GER）. Fifty-two patients received barium swallow, and 38 patients received gastroscopy and esophageal mucosal biopsy during follow-up. Results All the 60 patients were successfully discharged. Average length of hospital stay was 12.0±2.6 days. Average time for anastomosis was 18.4±3.2 minutes. The incidence of anastomotic leak was 1.7% （1/60）. During follow-up, all the 60 patients restored normal food intake, and 14 patients （23.3%） had GER symptoms. Barium swallow showed the average anastomotic diameter of 1.6_ 0.2 cm （range, 1.2 to 2.2 cm）. In 45° trendelenburg position, 31 patients （ 59.6% ） had barium GER, but none of the patients had prolonged barium retention, intrathoracic gastric dilation or dis- turbed gastric emptying. Gastroscopy of 38 patients showed full anastomotic opening in 24 patients （63.2%）and irregular or semiclosed anastomosis in the other 14 patients （36.8%）. Mucosal biopsy under gastroscopy showed chronic inflammation in 18.4% （7/38）patients. Conclusion Complete mechanical cervical side-to-side esophago-gastric tube anastomos