食管胃吻合口的组织学病理学功能学及临床研究

A Serial Study of the Histology, Pathology ,Function and Clinical Trial of the Anastomosis Following Different Esophagogastrostomies

通过实验研究及８７１例病人的临床观察和部分病例连续２４小时食管ｐＨ监测，对部分食管切除食管胃端侧吻合术的术后胸内吻合口瘘发生率、吻合口的愈合过程、胶原含量的改变、抗反流的效果和发生吻合口瘘后保守治疗的结果等５个方面，与“隧道式”吻合术进行对比。结果表明“隧道式”吻合术的吻合口瘘发生率低，愈合过程快，吻合口胶原含量和胶原回升量高，有较好的抗反流效果；一旦发生胸内吻合口瘘后保守治疗效果好。因此我们认为“隧道式”吻合优于端侧式食管胃吻合术。

Based on clinical observation of a group of 871cases and laboratory findings together with 24 hour continuons monitoring of esophageal PH changes on a portion of the patients, the 'Tunnel' esophagogastrostomy was compared with the end-to-side anastomosis following partial esophagectomy. Fixe parameters were examined including the rate of an stomotic leakage, the healing process, the collagen level.the anti-reflux effect and the result of conservative treatment for the intrathoracic anastomotic leakage.It was found that the rate of anastomotic leakgae was lower, the healing process was faster, the collagen level in different segments around the anastomosis during the early phase of the healing process decreased with a narrower range and normal collagen level was restored earlier and more quickly. The antireflux effect was much better and the result of conservative treatment for the anastomotic leakage was markedly better in the 'Tunnel' esophagogastrostomy group.It was concluded that the 'Tunnel' esophagogastrostomy was superior to the end-to-side anastomosis.