机械吻合器在食管癌和贲门癌手术中的应用

目的评价消化道圆型吻合器在食管癌和贲门癌手术中的应用价值。方法1980年8月至2004年9月期间应用圆型吻合器对3322例食管、贲门癌切除后进行机械吻合,其中男性2642例,女性680例;食管癌2312例,贲门癌1010例;食管胃颈部吻合102例,胸顶吻合147例,弓上吻合1838例,弓下吻合1235例。结果术后出现吻合口瘘18例（0．54％）,包括胸内吻合口瘘11例和颈部吻合121瘘7例。因胸内吻合口瘘死亡9例（81．8％）。发生术后吻合121狭窄66例（2．0％）,术中吻合出现器械故障36例（1．1％）。结论消化道圆型吻合器在上消化道重建手术中是安全可靠的,机械吻合是减少术后吻合口瘘的有效技术。

The application of stapling device in surgery of carcinoma of the esophagus and cardia

Objective To evaluate the application of circular stapler in upper digestive tract reconstruction. Methods We present a retrospective review of 3322 patients with Carcinoma of esophagus and cardia undergoing a stapled esophagogastric anastomosis from August 1980 to September 2004. There were 2642 males and 680 females with age ranged from 28 to 83 years old. Carcinoma of esophagus was present in 2312 patients and carcinoma of gastric cardia in 1010 patients. The anastomosis was performed in the cervical region in 102 cases, thoracic apex in 147 cases, up aortic in 1838 cases and below aortic in 1235 cases. Results Anastomotic leakage occurred in 18 patients with an overall incidence of 0. 54%, including thoracic leakage in 11 cases and cervical leakage in 7 cases, nine patients were dead because of the thoracic leakage, and the mortality of thoracic leakage was 81.8%. Benign anastomotic stricture was found in 66 patients with a rate of 2. 0%, and instrumental failure occurred in 36 patients with a rate of 1.1%. Conclusion Circular stapler can be used safely and reliably in upper digestive tract surgery, and the stapled anastomosis is an effective technique to reduce the incidence of anastomotic leakage.