机械吻合在食管外科中的应用（1605例经验总结）

Effect of Stapled Anastomosis in Surgery of the Esophagus(Experience of 1605 Cases)

１９８０年８月至１９９４年２月应用机械方法对１６０５例食管癌和贲门癌切除后进行吻合。男１２８１例，女３２４例。年龄２８～８１岁，其中５０～６９岁１１８４例（７３．８％）。食管癌１０４４例，贲门癌５６１例。食管胃颈部吻合３５例；超胸顶吻合５８例；弓上吻合８３５例；弓下吻合６７７例。术后发生吻合口瘘１６例（ｌ％），其中颈部吻合口瘘发生率１４．３％（５／３５）；胸内吻合口瘘发生率０．７％（１１／１５７０），前６年胸内吻合口瘘发生率１．４％（８／５７５），近８年胸内吻合口瘘发生率０．３％（３／９９５）。术后发生吻合口狭窄１６例（１％），狭窄明显者经扩张后均恢复正常饮食。作者认为：机械吻合是减少胸内吻合口瘘的有效方法之一。

Leakage at the anastomotic site in esophageal surgery remains an annoying problem to both patients and thoracic surgeons.Many papers have reported the advantages of using the stapling device in esophageal anastomosis.In order to reveal the merits of stapling anastomosis in esophageal surgery,this paper summarized the experience of stabling anastomosis in the resectional treatment for carcinoma of the esopohagus and gastric cardia on l605 patients admitted to the Department of Thoracic Surgery,General Hospital,PLA from August 1980 to February 1994.There were 1281 males and 324 females with a ratio of 3.95:1.Their age ranged from 28 to 8l years old with 1184 patients(73.8%)belonging to 50 to 69 age group.Carcinoma of the esophagus was present in 1044 patients and carcinoma of the cardia in 561.The anastomosis was performed in the cervical region in 35 cases and intrathoracically in l570.Anastomotic leakage occurred in l6 patients with an overall incidence of l%(16/1605).In comparison,the incidence of anastomotic leakage in the cervical anastomosis group was 14.3%(5/35)versus 0.7%(11/1570) in the intrathoracic anastomosis group. However,the incidence of intrathoracic anastomotic leakage had been as high as l.4%(8/575)prior to l986 but thereafter,the incidence came down to 0.3%(3/995).Anastomotic stricture occurred in l6 patients(l%).The clinical experience indicates that stapling anastomosis with a stapling device is a very effective procedure in reducing the incidence of esophageal anastomotic leakage especially in the intrathoracic anastomosis.