管型吻合器在食管肿瘤及贲门癌手术中的应用

Application of anastomat in esophageal and gastric cardiac carcinoma resection

目的 观察食管肿瘤、贲门癌切除后应用管型吻合器吻合的手术效果.方法 食管、贲门癌切除后应用管型吻合器吻合患者1800例,采用管型吻合器行食管-胃颈部吻合182例、食管-胃、食管-空肠胸内吻合1296例、腹腔内吻合322例.观察应用上海GF-I型和YH-W一次性管型消化道吻合器致吻合口瘘、吻合口狭窄、吻合口出血和吻合器机械故障等并发症发生率.结果 术后发生吻合口瘘15例（15/1800,0.83%,上海GF-I型吻合器10例,YH-W一次性吻合器5例,χ2=11.32,P=0.0089）,其中颈部吻合口瘘6例;吻合口狭窄41例（41/1800,3.11%,上海GF-I型吻合器15例,YH-W一次性吻合器26例,χ2=3.842,P=0.0840）,吻合口狭窄经扩张均恢复正常饮食.吻合口出血21例（21/1800,1.16%,上海GF-I型吻合器13例,YH-W一次性吻合器8例,χ2=15.38,P=0.0046）.术中出现吻合器机械故障14例（14/1800,0.78%,上海GF-I型吻合器10例,YH-W一次性吻合器4例,χ2=14.52,P=0.0075）.结论 机械吻合是减少食管肿瘤、贲门癌术后并发症有效方法之一,YH-W一次性吻合器具有更高的临床应用价值.

Objective To analyse the effects of anastomat to the resection surgery in 1800 esophageal and gastric cardiac carcinoma patients. Methods The Esophagus-gaster and Esophagus-intestine were stapled by anastomat in the cervical region in 182 cases、 intrathoracically in 1296 cases and intraperitoneal in 322cases. The occurrence of complications caused by anastomat, including anastomotic fistula,anastomotic stricture,anastomotic bleeding and mechanical failure,were observed. Results Anastomotic fistula occurred in 15 cases （ 15/1800,0.83% ,ten cases took Shanghai-made GF-I anastomat ,five cases took YH-W single disposable single anastomat ）, among which 6 cases had the cervical anastomosis; Anastomotic stricture occurred in 41 cases （ 41 /1800,3.11%, fifteen cases took Shanghai-made GF-I anastomat, twenty-six took YH-W single disposable single anastomat） ,but all of them recovered after dilatation; Anastomotic bleeding occurred in 21 cases （21/18001.16%, thirteen cases took Shanghai-made GF-I anastomat, eight took YH-W single disposable single anastomat） ;Anastomat mechanical failure in operation occurred in 14 cases（ 14/1800,0. 78% ,ten cases took Shanghai-made GF-I anastomat, four took YH-W single disposable single anastomat）. Conclusion Anastomat is an effective method in reducing the postoperational complications of esophageal and gastric cardiac carcinoma resection. Disposable single anastomat has higher clinical value.