防治逆蠕动式结肠代食管并发症的探讨

Prevention and cure of antiperistalsis of esophagus replacement with colon and complications

目的 :为探讨逆蠕动式结肠代食管反流及开发症的防治 ,方法 :对 3 8例需作逆蠕动式结肠代食管术者 ,随机分成两组 ,采取不同术式 ,A组行传统式逆蠕动结肠代食管术 12例。B组行胃结肠吻合口采用粘膜瓣吻合法 ,加张力固定代食管结肠颈腹部吻合口处施术 2 6例。结果 :A组返食 12例 ( 10 0 % ) ,颈吻合口瘘 6例 ( 5 0 % ) ,食管腔内压力 2 5 - 5kpa。B组返食 10例( 3 8% ) ,颈吻合口瘘 4例 ( 15 % ) ,食管腔内压力 1 3 - 2kpa。B组比A组降低返食 62 % ,降低颈吻合口瘘 3 5 % ,降低代食管腔内压力 1 2 - 3kpa后达到正常。结论 :粘膜瓣加张力固定法 ,可减少逆蠕动式结肠代食管返流及并发症。

Objective:To study the prevention of reflux as the complication resulting from esophagus replacement with colon by means of antiperistalsis. Method:In the last 16years, 38cases were analysed by dividing into two groups at random with different treat schemes. 12 cases in group A were under traditional surgical treatment. 26 cases in group B were given the method that mucosa and valve anastomosed respectively so as to strengthen the tension of anastomosis. Result: In group A, 12 patients incurred reflux(100%). 6 patients got cervical anastomotic leakage(50%).The esophageal intrapressure was 2.5～5kpa, While in group B, 10 incurred reflux(38%) and 4 were cervically anastomotic fistulous (15%) with the esophageal intrapressure between 1.3～2kpa Compared with group A, group B had decreased the reflux rate by 62% and leakage rate by 35%, and esophageal intrapressure dropped 1.2～3kpa reaching the normal level. Conclusion Additional tension to reinforce the mucosa valve can effectively decrease the probability of reflux and its complications after operation.