贲门癌根治术术中管状吻合器的使用优点及技巧探讨

Forte and technique of circular stapler application in radical correction of gastric cardia carcinoma

目的探讨贲门癌根治术（食管空肠吻合及残胃食管吻合）术中管状吻合器的使用优点及技巧。方法1998年-2007年本院753例贲门癌根治术行食管空肠吻合或残胃食管吻合重建消化管，术中均使用一次性管状吻合器。结果本组753例，无手术死亡，行胸腹联合手术6例（0．80％），无吻合121漏发生，吻合器切割不全2例（0．26％），发生吻合口狭窄4例（0．53％），腹腔感染1例（0．13％），膈疝1例（0．13％），术后标本病理检查上切缘癌累及1例，下切缘均未累及。结论在贲门癌根治术中，管状吻合器的运用简化了手工操作程序，可靠、安全、省时，降低贲门癌进胸手术比例，手术创伤小，恢复快，能有效地预防吻合口瘘和狭窄。但吻合器吻合也不是绝对安全的，吻合口瘘、出血、狭窄等并发症仍有一定的发生率，术中技巧值得在今后的工作中进一步总结、探讨。

Objective To investigate forte and technique in radical correction of gastric cardia carcinoma （ esophagojejunostomy and gastric stump esophago anastomosis）. Methods 753 Patients with gastric cardia carcinoma admitted to our hospital from 1998 to 2007 treated with radical correction by jejuno-esophagus anastomosis and esophagogastric anastomosis to digestive tract reconstruction, circular staplers were used in all cases. Results There was no death （ no leakage.bleeding and stricture of anastomotic entrance stenosis） in these cases by thoracoabdominal approach 6 cases, anastomotic leakage 0 case, pero-cutting 2 cases, steno- sis 4 cases, infection of abdominal cavity 1 case, diaphragmatic hernia 1 case, pathologic diagnosis of example after operation , the upper cut positive 1 case, the lower cut negative in all cases. Conclusions in radical correction gastric cardia carcinoma, the application of circular stapler makes this procedure simple, reliability, safety and time saving, descends the ratio of radical correction of gastric cardia carcinoma by thoracoabdominal approach, decreases surgical trauma, decurtate the period of recovery following an illness, prevent the complications of post-operation such as the leakage and stricture of anastomotic entrance. But the application of circular stapler is not absolutely trustworthy, there are also any ratio of leakage .haemorrhage and stricture of anastomotic entrance, the technique worth summarizing and investgating in the future.