颈部及超胸膜顶食管重建术中管状吻合器的临床应用

Clinical Application of the Circular Stapler in Cervical and Super-thoracic Esophgagus Reconstructions

目的:探讨管状吻合器在食管癌患者颈部及超胸膜顶食管重建术中的临床应用探讨。方法:食管肿瘤位置较高时,行颈部切口,游离颈段食管做荷包缝合,置入吻合器抵钉座,结扎荷包缝线,再连续全层锁边缝合食管残端结扎并固定于抵钉座,还纳抵钉座中心杆入食管床,于胸内完成吻合;肿瘤上缘位置较低时,经胸腔向上游离颈段食管,可切断第1、2肋间血管,同法置入固定吻合器抵钉座,经贲门置吻合器主件行食管胃底吻合。结果:117例食管癌患者,术后吻合口狭窄4例(3.4%),肺部感染3例(2.7%),食管残端癌残留2例(1.7%),吻合口瘘2例(1.7%)。结论:掌握手术技巧,注重吻合器操作的各个环节,颈部及超胸膜顶食管胃机械吻合可有效降低并发症发生率。

Objective： To investigate the clinical application of the circular stapler in cervical and super - thoracic esophagus reconstructions. Methods： When the esophageal tumor was in upper position, the cervical incision was made, the esophagus was free in jejunal grafts and sewn with purse string suture, the stapler anvil was inserted inside, ligated the suture, then the remnant esophagus was sewn continuously by through locking stitch and was positioned in the anvil, the anvil center rod was returned to the esophagus bed and the anastomosis was made within the chest; when the upper border of tumor were in lower position, the cervical esophagus was free in jejunal grafts along with the thorax and up, the first and second intercostal blood vessels were cut off and the stapler anvil was insert- ed and positioned in the same way, the esophageal gastric anastomosis was made by inserting staplers from the gastric cardia. Results： Among 117 cases, anastomofic stenosls 4 cases （ 3.4% ）, lung infection 3 cases （ 2.7% ）, the cancer residual of esophageal stomal 2 cases （ 1.7% ）, anastomotic leakage 2 cases （ 1.7% ）. Conclusion： The complications rate can be effectively reduced with the mechanical cervical and super-thoracic esophagogastric anastomosis by mastering operation techniques, paying attentions to operation details of staplers.