管状胃代食管在食管癌手术中的应用

目的探讨部分管状胃代食管经食管床、胃食管胸顶吻合的方法及临床疗效。方法本组152例食管癌患者全部经左胸第5,6肋间后外侧剖胸,保留胃网膜右血管及胃右血管2~3支,距幽门5 cm处用闭合器垂直于胃大弯逆向斜形切除胃小弯、贲门至胃底下方2 cm处,将近半胃制成直径约3 cm~4 cm的管状胃由食管床经弓后上提至胸顶与残留食管行端侧机械吻合。结果全组均为R0切除,无围术期死亡,发生吻合口瘘1例(0.6%),胸胃扩张2例(3.6%),乳糜胸1例(0.6%),肺部并发症9例(5.9%),心律失常7例(4.6%)。结论部分管状胃成形经食管床、胃食管胸顶吻合术符合消化道生理解剖要求,减少了胸胃综合征及反流,降低了术后吻合口瘘和心肺并发症发生率,提高了患者的生活质量。

Clinical application of gastric tube in reconstruction during esophagus cancer operation

Objective To investigate the method and clinical efficacy of gastric tube anastomosed at the top of thorax through esophageal bed.Methods 152 cases were all left posterolateral thoracotomy through 5th or 6th intercostal,and the right gastroepiploic vessels and 2-3 branches of the right gastric vessels were reserved,and lesser curvature,cardia were removed backwards from 5cm upto pylorus to 2cm at the bottom of gastric by stapler.Nearly half of gastric was made into tube with diameter 3 cm~4 cm,and anastomosed at the top of thorax through esophageal bed with remaning esophagus by anastomat.Results The group were all R0 resection,with no Perioperative death,anastomotic leakage 1(0.6%),dilatation of gastric tube 2(3.6%),chylothorax 1(0.6%),pulmonary complications 9(5.9%) and arrhythmia 7(4.6%).Conclusion The method of gastric tube through esophageal bed,anastomosing at the top of thorax meets the requirements of the digestive tract anatomy and physiology,reduces incidences of chest syndrome,reflux of gastric,anastomotic leakage and cardiopulmonary complications,and improves the quality of life.