食管癌术后吻合口狭窄的预防

Prevention of anastomotic stricture after carcinoma of esophagus resection

目的探讨改进食管癌手术吻合口吻合方法以减少吻合口狭窄的可行性.方法回顾性分析5642例食管癌根治术采用不同吻合方法.颈部:胃壁横形切开,常规手工吻合(简称A1);胃壁圆形切口,其口径与食管相当(简称A2).器械吻合(简称A3).胸内吻合:器械吻合(简称B1);胃壁加缝一直径与吻合器直径相当的荷包器械吻合(简称B2).结果吻合口狭窄发生率:颈部吻合A1组29/842例(3.4 %);A2组4/372例(1.07 %);A3组2/481例(0.4%).胸内吻合:B1组73/3144(2.32%);B2组3/803(0.37%).狭窄程度:轻度(0.5～0.8cm)28例;中度(0.3～0.5cm)70例;重度(0.3cm以下)13例.狭窄率相比较,A2和A1组比较,A3和A1组相比较;B2组和B1组相比较,χ2检验,P<0.05.改进后的方法均优于原先的方法. 结论食管癌手术吻合口吻合方式改进能有效减少吻合口狭窄的发生.

Objective To explore the possibility of reduce anastomotic stricture by improving anastomosis procedures during the esophgogastrostomy due to the carcinoma of the esophagus.Methods To analyze the results of 5642 cases with esophagogastrostomy and esophago-gastro anastomosis. Cervical anastomosis:Transerse incision of stomach with hand suture anastomosis(A1).Round incision which equals to the cut end of esophagus in diameter of stomach with hand suture anastomosis(A2).Staple anastomosis.Intra-thoracic anastomosis:Staple anastomosis(B1),Staple anastomosis with a sewing a pouch which equals to the stapler in diameter of the stomach wall.(B2).Results The rate of anastomotic stricture following esophagogastrostomy was 3.4%(29/842)in groupA1,1.07%(4/372)in group A2,0.4%(2/481)in group A3,2.32%(73/3144)in group B1,.37%(3/803)in group B2 respectively.The degree of anastomotic stricture was classified into three groups according to the diameter of anastomosis lumen.The group of light degree was 28 cases with 0.5～0.8cm.the middle degree group 70 cases with 0.3～0.5cm. Heavy anastomotic stricture 13 cases with <0.3cm.The all findings were analyzed with χ2 test.The rates of anastomotic stricture in group A2 and A3 were significantly lower than that in group A1(P<0.5). Also the rate of anastomotic stricture in group B2 was significantly lower than that in group B1(P<0.05). Conclusion The anastomotic procedures improved by us are able to reduce the rate of anastomotic stricture following the esophgogastrostomy.