食管胃胸内器械吻合术后吻合口狭窄的预防

Prevent of anastomotic stoma stenosis after esophag-stomach apparatus anastomosis in chest

目的:总结使用吻合器术后并发吻合口狭窄的原因,探讨改进吻合方法以减少吻合口狭窄的可行性。方法:回顾性分析482例经左胸食管(贲门)癌切除,食管胃胸内器械吻合。常规组:器械吻合,胃壁包埋吻合口部位食管长约3cm;改进组:器械吻合前,胃壁加缝一直径与吻合器直径相当的荷包缝合,订合成功后,胃与吻合口上方2cm处纵隔胸膜悬吊数针。结果:吻合口狭窄发生率常规组8/208(3.85%),改进组4/274(1.46%)。结论:改进食管(贲门)癌手术吻合口吻合方法能有效减少吻合口狭窄的发生。

Objective： To summarize the cause of anastomotie stoma stenosis after esophag - stomach apparatus anastomosis in chest, and propose an approach to decrease the incidence of stenosis. Methods： The clinical data of 482 cases of esophag - stenach apparatus anastomosis in chest for 10 years were analyzed retrospectively. The control group： After anastomosis, the esophagus near the anastomotic stoma were embed in gastric wall for 3cm. The experimental group： Before anastomosis, A purse string suture were stitched in gastric wall whose diameter were suitable to the stapler. When anastomosis accomplished, the gastric wall were stitched to the mediastinal pleura 2cm upper the anastomotic stoma. Results： The incidence of anastomotic stoma stenosis, the control group 3.85 % （ 8/208 ）, the experimental group 1.46 % （4/274）. Condusion： The new approach could decrease the incidence of anastomotic stoma stenosis effectively.