全胃切除术食管空肠机械吻合法改进

Improvement in Mechanical Anastomosis for Total Gastrectomy

全文报告全胃切除术42例,食管空肠吻合采用GF-I型吻合器吻合,在Schlatter's法基础上作下列改进:①延长空肠系膜长度。②食管残端用绕边全层荷包缝合法置中心杆入食管腔,结扎荷包线于中心杆上。⑧食管空肠吻合口下方3cm结扎近端空肠。④在食管空肠准备吻合处下方5cm切开远端空肠2cm^3cm,经此口置吻合器完成食管空肠吻合术。距食管空肠吻合口40cm处作Braun's吻合口。此组无吻合口瘘和返流性食管炎并发症。

From February 1992 to August 1993, 42 cases of total gastrecto-my were performed using GF-1 Anastomat during esophagojejunostomy. Modifications on the Schlatter' s operative procedures were made as follows. 1. The length of mesojejunum was extended. 2. Purse-string suture was placed at cutting end of the esophagus and tied over the axial rod of the stapler. 3. The afferent loop of the jejunum was ligated at a point 3cm proximal to anastomosis of esophagus and jejunum. 4. The stapler was introduced through a slot 2cm-3cm long on the efferent loop of the jejunum at a site 5cm off the esophagojejunal anastomosis which was accomplished through this incision. Braun' s anastomosis was performed 40cm away from the esophageal-jejunum anastomotic stoma. There have been no cases of anas-tomotic fistula formation nor reflux esophagitis occurred.