食管管状吻合器运用中降低吻合口瘘的探讨

目的研究通过改进对食管残端的处理降低吻合口瘘的发生.方法在我院接受食管贲门癌切除术并使用管状吻合器重建食管的480例患者根据术中食管残端处理方法的不同分为两组.第一组300例,食管残端用荷包钳法作荷包处理;第二组180例,食管残端在荷包钳处理的基础上,再间断全层缝合食管壁并结扎缝线,或沿食管残端连续全层缝合一周,放入抵钉座后结扎缝线.结果第一组患者吻合结束后检查切下的食管圈有10例黏膜不完整,吻合口瘘8例;第二组患者食管圈均完整,无吻合口瘘发生.结论对食管残端处理的改进有助于减少术后吻合口瘘.

Oversewing the Esophageal Stump-A Way to Decrease the Occurrence of Anastomotic Leak

Purpose To investigate if improved treatment of the esophageal stump could decrease the occurrence of anastomotic leak. Methods Among 480 patients who underwent esophagectomy with circular stapler, two groups were divided according to the difference of the treatment for the esophageal stump. Group one consisted of 300 patients whose esophageal stumps were treated by a purse stitch using a clamp. Group two included 180 patients whose esophageal stumps were oversewn by 6-8 interrupted stitches, or by a continuous stitch along the stump before the anvil was in place. Results There were 8 anastomotic leaks in group one and none in group two. Conclusions Oversewing the esophageal stump is beneficial for decreasing the occurrence of anastomotic leak.