食管癌和贲门癌术后吻合口重度瘢痕狭窄的外科治疗

Surgical treatment of severe cicatricial anastomotic stricture after esophagectomy for esophageal and cardiac cancer

目的总结食管癌和贲门癌术后吻合口重度瘢痕狭窄外科治疗的经验。方法对24例重度吻合口瘢痕狭窄并下咽困难的患者行二次手术治疗。其中,原发肿瘤为食管癌17例(9例为颈部食管胃吻合,8例为胸内食管胃弓上吻合),贲门癌7例(6例为胸内食管胃弓下吻合,1例为经腹食管胃膈下吻合);狭窄段长0.3～0.5cm、在瘢痕基础上形成蹼状者18例,狭窄段长0.5～1.0cm、环形狭窄呈收缩状者6例。二次手术解剖吻合区的吻合口上下各1～2cm范围,在距吻合线上下各2～4mm处分别切开一半食管腔和胃腔,然后切除部分瘢痕狭窄环组织,再行食管胃单层吻合。结果24例成功地完成二次手术,1例出现颈部吻合口瘘,无手术死亡。术后随诊2～3年,患者可顺利进软食和普食,未发生二次吻合口狭窄,生活质量明显提高。结论食管癌和贲门癌术后发生的吻合口重度瘢痕狭窄,可行二次手术切除部分瘢痕狭窄环再吻合,效果较好。

Objective To review the experience of the surgical procedure in the treatment of postoperative severe cicatricial anastomotic stricture for esophageal cancer and cardiac cancer. Methods Twenty-four cases with severe anastomotic strictures and dysphagia after esophagectomy underwent second operation. The anastomosis was opened by two small transverse incisions about 1—2 mm above and below the anastomotic line. The esophageal and gastric walls were half opened. Then the circular cicatricial tissue was partially removed. The re-anastomosis was performed with a one layer, intermittent technique. Results The second operations were successfully completed in 24 cases, cervical anastomotic leakage happened in 1 case and no operative mortality. All cases were followed up for 2—3 years. All patients can eat soft and common diet smoothly. No anastomotic strictures were found and the quality of life was significantly improved. Conclusion The second surgery with partial removal of the narrow cicatricial ring and reanastomosis for postoperative severe anastomotic stricture after esophagectomy is feasible, and the result is satisfactory.