经胃粘膜下层食管胃粘膜单层吻合的临床研究

目的：探讨预防食管胃吻合术吻合口瘘、吻合口狭窄以及反流性食管炎的手术方法。方法：按根治要求切除恶性肿瘤，关闭残胃断端，在保留胃的前壁分别置作3cm宽的隧道出、入口，出、入口间距为3cm，经胃粘膜下层打通出、入口，构成胃壁“隧道”。游离食管粘膜3cm，由隧道入口至出口，距出口远端胃浆肌层断缘0．5cm处，横行切开胃粘膜3cm作为吻合口，行食管胃粘膜单层吻合，关闭出、入口，置游离的食管粘膜于隧道内。结果：本组300例术后无1例早期死亡和发生吻合口瘘，吻合口狭窄和反流性食管炎各2例。结论：经胃粘膜下层食管胃粘膜单层吻合可以预防吻合口瘘、吻合口狭窄和反流性食管炎。

The Clinical Research of Transgastrosubmucosa Gastroesophageal Mucosa-mucosa Anastomosis

Objective: To testify whether transgastrosubmucosa gastroesophageal mucosa muscosa anastomosis is able to decrease the incidence of anastomotic leak, stenosis and reflux esophagitis after gastroesophageal anastomosis. Methods: A total of 300 patients who had radical resection of esophageal carcinoma were enrolled into the study. Two transverse incisions were made separately on the anterior wall as entrance and exit 3 cm apart and a tunnel was made in the anterior wall of the residual stomach between the incisions. The dissected esophageal mucosa was introuduced through the tunnel longitudinally between submucosal and seromuscular layers of the wall. Then gastric mucosa was cut about 3 cm wide and 0.5 cm above the exit where the gastroesophageal mucosa mucosa anastomosis was done. The exit and entrance were closed and the dissected esophageal mucosa preserved in the tunnel. Results: Among all the 300 patients in the study, none of anastomotic leak and no perioperative death occurred. There are only two cases of stenosis and two cases of reflux esophagitis. Conclusions: The new type of transgastrosubumucosa gastroesophageal mucosa mucosa anastomosis may decrease complications such as anastomotic leak, stenosis and postoperative reflux esophagitis of radical resection of esophageal carcinoma.