食管胃主动脉弓上吻合新方法──纵隔胸膜包盖悬吊术

A NEW TECHNIQUE OF ESOPHAGOGASTROSTOMY ABOVE THE AORTIC ARCH──COVERING AND SUSPENDING OF THE ANASTOMOTIC AREA WITH MEDIASTINAL PLEURA FLAP

吻合口瘘是食管癌切除术后最严重的并发症和主要死亡原因，尤其是主动脉弓上吻合，不但瘘的发生率高，而且预后凶险。作者对传统的吻合方法进行了改进，采用纵隔胸膜包盖悬吊术，取得了满意的结果。１９９０年１月～１９９５年４月共行食管癌切除、主动脉弓上食管胃吻合术２１０例，术后无吻合口瘘及近期狭窄，仅１例死于广泛心肌梗塞，死亡率为０．５％。该吻合方法的特点在于纵隔胸膜瓣可紧密地包盖在吻合口区，并且承担了一切作用于吻合口的牵拉力，使吻合口在一个很安静的环境中愈合，从而减少或防止了吻合口瘘的发生。

AbstractThe postoperative anastomotic leakage is the most severe complication and the principalcause of death after resection of esophageal carcinoma. Especially,anastomosis above the aorticarch is accompanied by high incidence of anastomotic leakage usually with fatal prognosis. Theauthors improved the conventional method of anastomosis by using a mediastinal pleura flap tocover and suspend the anastomotic area with excellent result.From January of 1990 to April of1995,210 patients with esophageal carcinoma were so treated. No anastomotic leakage or stric-ture developed.Only one patient died of extensive myocardial infarction with an overall mortalityof 0.47%。The major merit of this procedure was that the mediastinal pleura flap could cover thearea of anastomosis and sustain the dragging force acting on this area, providing a better condi-tion for the anastomosis to heal and thus reducing the possibility of anastomotic leakage.