食管胃机械吻合的临床应用和随访

Clinical Application and Follow-up Survey of Mechanical Esophagagastrostomy

本文报告了作者自1986年至1994年期间对247例食管癌、责门癌患者行食管胃机械吻合的经验和随访情况。方法：采用A组不设禁忌证，单纯使用吻合器行消化道重建，一次吻合成功；B组掌握适应证，并实施抗吻合口狭窄抗返流操作，两组均采用上海GF－Ⅰ型（φ＝28mm）消化道吻合器。结果：获访228例（92．3％）。吻合口内径＜1．0cm者A组14．4％（其中内径＜0．8cm者8．4％）；B组3．6％。返流率A组74％，B组8．2％。结论：使用吻合器有简便、省时、吻合口瘘发生率低的优点，但易致吻合口狭窄。若在吻合后加4～8针缝线使吻合口粘膜对合良好，可减少狭窄的机会，应用时应严格掌握适应证，吻合完毕后将胃包埋食管，对预防术后返流是必要的。

The clinical experience and follow-up results of 247 cases of esophageal and cardia carcinomastreated with mechanical esophagagastrostomy from 1986 to 1994 are reported in this paper. Method: Allpatients divided into two groups were operated on with type GF-I anastomat(made in Shanghai, φ =28mm). The esophagagastrostomy were performed only by using anastomat and there were no contraindications in group A; Close attention to indication and preventing reflux and stricture was paid in group B. Result:The follow-up rate was 92. 3% (228/247), internal diameter of anastomotic stoma < 1 .0cm was14.4% in group A,and 3.6% in group B.The rate of reflux was 74% in group A and 8.2% in groupB. Conclusion: The anastomat was easily performed and the occurance rate of anastomotic leakage was lower, resulting in anastomotic stricture. Drawing 4 ~ 8 wire sutures in anastomotic stoma may prevent strictureafter anastomosis. It is necessarp to pay attention to the indication and to prevent reflux after operation bycovering up the esophagus with the stomach.