颈部胃食管吻合术中管状吻合器应用的体会

The use of circular stapler in cervical esophagogastromy

目的改进颈部胃食管吻合时管状吻合器的使用方法。方法对25例食管癌患者作食管癌根治术并用管状吻合器进行胃食管颈部吻合。吻合的技术要点包括用荷包钳作荷包后将食管残株黏膜与肌层缝合固定数针;用卵圆钳扩张后放入抵钉座,先经胃后壁引入胃内,再在颈部将吻合器主件经胃前壁切口插入胃中与之结合完成吻合。结果术后无吻合口瘘发生。因肺部感染死亡1例;术后3个月吻合口狭窄1例,经口扩张后好转。结论改进吻合器的使用方法后,颈部胃食管吻合取得满意的效果。

Purpose To investigate the effect of the circular stapler for cervical esophagogastromy with modified procedure. Methods Twenty-five patients underwent cervical esophagogastromy using the circular stapler after radical resection of the esophageal cancer. The important modification made to the procedure includes dilatation of the esophageal stump, oversewing the stump in addition to the purse stitch, and introduction of the anvil into the stomach before the stapler is inserted into the stomach from the neck. Results One patient died due to severe lung infection; no anastomotic leak occurred; 1 patient suffered from fibrous anastomotic stricture and improved after instrument dilatation. Conclusions The modified use of the circular stapler in cervical esophagogastromy results in satisfactory clinical outcome and is easy to apply.