胸内食管胃端侧器械吻合1555例的经验和体会

Clinical Experience of Intrathoracic Esophagogastric Instrumental Anastomosis in 1555 Cases

目的:总结胸下段食管癌或贲门癌切除术后胸内食管胃端侧器械吻合的经验和体会。方法:对1990年1月至2005年6月间行胸下段食管癌或贲门癌切除食管胃端侧器械吻合术共1555例做回顾性分析。结果:手术平均耗时2小时40分钟。术后吻合口少量出血24例、吻合口瘘16例、吻合口狭窄32例、胃食管返流110例,发生率分别为1.54%、1.03%、2.06%和7.07%。术后3个月内发生吻合口胸主动脉瘘9例(0.58%),其中手术止血成功4例,死亡5例。结论:应用管状消化道吻合器行胸内食管胃端侧吻合术效果可靠,操作方便,易于掌握,值得推广应用,但仍有一定比例的并发症发生,尤其是吻合口胸主动脉瘘,应引起重视。

Objective： To summarize the experience and understanding of the instrumental anastomosis of intrathoracic esophagogastria after excision of inferior esophageal carcinoma or carcinoma of the gastric cardia. Methods： Retrospective analysis was conducted for 1555 cases with resection of inferior esophageal carcinoma or carcinoma of the gastric cardia who received postoperative esophagogastric anastomosis during a period from January. 1990 to June 2005. Results： The mean operation time was 2 h and 40 min. After surgery, the incidence of slight postoperative bleeding at the stoma, anastomotic fistulae, anastomotic stricture, and gastroesophageal reflux was 1.54%, 1.03%, 2.06% and 7.07%, respectively. Aortic sinus fistulae at the stoma occurred in 9 cases within 3 months （0.58%）, among which successful surgical hemostasis was achieved in 4 eases and death occurred in 5 cases. Conclusion： It is believed that the effect of intrathoracic esophagogastric end-to-side anastomosis, using a tubiform digestive-tract stapler, is reliable. The stapler is convenient for use in surgery, is easy to grasp and deserves popularization in its application. However, complications that eannot be ignored still occur, especially the aortic sinus fistulae at the stoma which is extremely hazardous and requires special attention.