食管吻合器的临床应用研究

THE CLINICAL STUDY OF USING THE ESOPHAGEAL STAPLER

收集我院１９８０．１～１９８７．１２八年间的胸段食管癌和贲门癌切除后，食管胃吻合术３５９例，其中吻合器组２０７例，手缝组１５２例，两组病例的年龄、性别和病期相当，手术者大致相同，分组无选择。结果吻合器组的中数手术耗时（３时４０分〕比手缝组（４时３０分）短，中数术后住院时间亦从２０天缩短至１６天。吻合口宽度＞ｌｃｍ者，前者占８５．９％，后者仅占７８．８％；前者有９７．Ｏ％，后者仅９３．８％的病例术后可进普食。吻合器组的吻合口瘘和术后死亡率分别为３．４％和１．０％，而手缝组则分别为５．３％和３．９％。轻、中、重度吻合口狭窄的发生率于前者分别为１．４％、０．５％和１．Ｏ％，而后者则分别为３．３％、２．６％总和０。可见吻合器组的效果比手缝组优。本文还对ＧＦ一Ｉ型吻合器的评价，吻合器大小的选择及操作程序进行了讨论。

In this paper we have collected 350 cases of esophagogas-anastomosis aft-er resecting the thoracic erophageal cancer and cardial cancer in our hosnitalpbetween Jan-198O and Dec.l987(207 cases with the stapler technique and 152 cases with the hand tech-nique).The age,sex and stage of those cases were similar in two groups at random.Themedian operating time with stapler(3 hours and 40 minutes) was shorter than that with hand(4 hours and 30 minutes).After operating,the median hospitalized time was decreased from20 days to l6 days The anastomotic size which was larger than l cm was 85.9% in the for-mer and 78.8% in the latter. After operatlng, 97.0%of the patients can have ordinary mealin the former, and only 93.8% in the latter.The anastomotic leakage and mortality rate were3.4%and 1.0%,respectively in the group with stapler,and were 5.3%and 3.9%, respecti-vely in the group with hand。 The slight.middle and strong anastomotic stricture rate were1.4%,O.5%and l.O%,respectively in the former,and 3,3%,2.6%and 0%。 respectivelyin the latter .In conclusion,the effect with stapler is better than that with hand. We alsodiscuss on GFI stapler about its evaluation selection of size and procedure.