lvor-lewis术中胸腔内全机械性食管胃侧侧吻合应用

Application of Total Mechanical Stapled Intrathoracic Side-to-Side Esophagogastric Anastomosis during Ivor-Lewis Esophagectomy

目的:探讨Ivor-lewis术中胸腔内全机械性食管胃侧侧吻合应用的安全性及效果。方法:自2009年1月至2011年2月在Ivor-lewis食管癌根治术中应用直线型切割缝合器纵向缝合食管胃吻合口后壁,使吻合口后壁延长至3cm以上,同时应用直线型切割缝合器闭合吻合口前壁,完成食管胃侧侧吻合18例。术后随访观察进食情况,纤维胃镜、造影评估吻合口内径。结果:17例顺利完成胸腔内全机械性食管胃侧侧吻合;术后均无吻合口瘘,切缘无癌残留。术后随访3～24个月,进食通畅,行胃镜检查7例,造影检查15例,1例患者吻合口轻度狭窄,无因吻合口狭窄行内镜扩张,吻合口面积为(2.23±0.35)cm^2。结论:Ivor-lewis术中胸腔内全机械性食管胃侧侧吻合应用安全可靠,能够有效改善患者术后吻合口狭窄发生,从而减少因吻合口狭窄行内镜扩张次数,但由于缺乏科学的随机对照研究,因此尚不能明确其是否可以替代传统管型吻合器吻合。

Objective： To study the advantages of total mechanical stapled intrathoracic esophagogastric anastomosis during esophageetomy, Methods： Total mechanical stapled intrathoracic side-to-side esophagogastric anastomosis was performed in 18 patients that underwent Ivor-Lewis esophagectomy from January 2009 to February 2011. The procedure was done using a linear cutting and stitching instrument to conduct a lengthwise suture of the posterior wall of the esophagogastric anastomotic stoma to extend the posterior wall of the esophagogastric anastomotic stoma by at least 3 cm. Then, the stitching instrument was also used to close the anterior wall of the stoma. Follow up was conducted on all patients. Gastrofiberscopy and barium swallow contrast examination were conducted to assess the inner diameter of the stoma. Results： Total mechanical stapled intrathoracic side-to-side anastomoses were smoothly performed in 17 of the 18 cases. No postoperative fistula and remnants of the surgical margin were found in these cases. All the cases were followed up for 3 to 24 months. Food intake was easy and smooth for the patients. Gastrofiberscopy was conducted in seven of the cases, and contrast examination was conducted in 15 cases. Slight stenosis of the anastomotic stoma was found in only one patient, and endoscopic dilation was not used. The area of the stoma was （2.23 ± 0.35） cm2. Conclusion： Total mechanical stapled intrathoracic esophagogastric anastomosis during esophagectomy is safe. It can effectively reduce the postoperative stricture rate and the need for dilation. Considering the lack of a randomized control study, whether the method can substitute for traditional anastomosis using a tubulation stapler remains unclear. Further studies are therefore needed.