器械吻合在胸中下段食管癌手术中应用231例

Mechanical anastomosis after surgical removal of esophageal carcinoma:an analysis of 231 cases

目的:总结胸中下段食管癌切除术后胸内食管胃端侧器械吻合的经验和体会.方法:使用国产WH-Y型胃肠吻合器对231例胸中下段食管癌患者进行胸内器械吻合.231例患者术前均经上消化道钡餐造影及纤维胃镜病理检查明确诊断为食管鳞癌.其中胸中段食管癌51例,下段食管癌180例.病变长度0.512cm.本文回顾性分析2005-01/2009-12食管癌患者231例的临床资料.结果:本组231例中,吻合口瘘3例,发生率1.30%(3/231),其中死亡1例,为术后4d出现吻合口瘘.余2例为术后10d出现吻合口瘘,均经通畅引流、营养支持等内科保守治疗治愈.术后4w发生吻合口狭窄2.16%(3/231),均予以胃镜下球囊扩张后治愈.本组手术平均耗时160min,出血平均为500mL,术后平均住院15d.术后随访207例,1、3、5年生存率为53.1%、27.5%、18.4%.结论:应用器械吻合行胸内食管胃端侧吻合术效果可靠,操作方便.

AIM：To evaluate the clinical value of mechanical anastomosis after surgical removal of esophageal carcinoma.METHODS：The clinical data for 231 patients who underwent surgical resection of middle and inferior esophageal carcinoma located in the middle and inferior segments and received esophagogastric anastomosis using a domestic WH-Y gastrointestinal stapler from January 2005 to November 2009 were retrospectively analyzed.RESULTS：Of 231 cases,the incidence of anastomotic fistula was 1.30% （3/231）.One patient developed anastomotic fistula on postoperative day 4 and died,and two patients developed anastomotic fistula on postoperative day 10 and were cured after medical conservative treatment.The incidence of anastomotic constriction was 2.16% （3/231） after 4 weeks,and all cases were cured after endoscopic balloon dilation.The mean operation time,average bleeding volume and mean postoperative hospital stay were 160min,500 mL and 15 d,respectively.A total of 207 patients were followed up,and the 1-,3and 5-year survival rates were 53.1%,27.5% and 18.4%,respectively.CONCLUSION：Intrathoracic esophagogastric end-to-side anastomosis using a stapler is reliable in the management of patients after surgical removal of esophageal carcinoma.