改良舌状浆肌瓣覆盖——颈部食管胃黏膜吻合术306例

Evaluation of Cervical Anastomotic Effect with Esophagogastrostomy Covered by Tongue-like Sero-muscular Flap of Gastric Wall in Cases of Esophageal Cancer

目的 观察食管癌切除术后改良舌状浆肌瓣覆盖颈部食管胃黏膜吻合术对于预防吻合口相关并发症的作用，及患者术后生活质量。方法 采用改良舌状浆肌瓣覆盖食管胃黏膜颈部食管胃／下咽胃吻合术的306例食管癌患者手术后吻合口愈合情况及患者术后生活质量。结果 全组术后吻合口瘘发生11例（3．6％）。术后两周X线检查见钡剂通过顺利，吻合口呈直线状。其中94例术后3～6个月行食管镜检查，见吻合口黏膜光滑直径1．0～2．0cm，吻合口上方食管黏膜正常，未见返流性食管炎征象。全组无手术死亡病例。结论该方法操作简便，对预防术后颈部吻合口瘘、吻合口狭窄及返流性食管炎有较明显的作用。其抗返流作用与吻合口前壁突人胃腔类似瓣膜结构有关。

Objective To prevent cervical anastomotic leak ,anastomotic stricture and reflux esophagitis after resection of esophageal cancer. Method From October 1997 to March 2007,306 cases of esophageal cancer were operated by a procedure ＂esophagogastrostomy covered by improved tongue-like seromuscular flap of gastric wall＂. Results No anastomotic complications happened after operation. Within 3-6months after operation 94 cases were examined by esophagoscope. The anastomotic diameter within 1.0-2.0cm and the superior esophageal velum of the anastomose was natural. Conclusion The operative procedure is simple and reliably. It can prevent anastomotic leak anastomotic stricture and reflux esophagitis after the resection of esophageal cancer.