食管贲门癌切除后管状吻合器重建食管300例

Reconstruction of Esophagus with Circular Stapler Following Radical Resection of Esophageal and Cardiac Cancers in 300 Patients

目的 探讨管状吻合器重建食管的优缺点和技术要点。方法 复习近年在我科接受食管贲门癌根治术的 3 0 0例患者的病史 ,记录所发生的并发症和有关因素。结果 本组病人全部采用吻合器重建食管。术后吻合口瘘 8例 ,吻合口出血 2例 ,胸腔出血 1例 ,乳糜胸 1例 ,吻合口狭窄 4例。除 1例吻合口瘘死亡外 ,其余均康复。结论 管状吻合器重建食管的技术要点包括食管的完整切割、吻合器的旋钮松紧适度、切除的胃圈面积足够大。吻合器对操作医师的技术要求相对低 ,并且耗时少、创伤小 。

Purpose. To investigate the advantages and important issues that should be noted in the use of circular stapler. Methods. The histories of 300 patients who underwent radical resection of esophageal and cardiac cancer in our department were reviewed. Postoperative complications and relevant risk factors were recorded. Results. Esophageal reconstruction were performed with circular stapler in all cases. There were anastomotic leak in 8 patients, anastomotic hemorrhage in 2, anastomotic structure in 4, hemorrhage in the pleural cavity in 1, and chylothorax in one. All recovered except one anastomotic leak patient who subsequently died. Conclusions. For stomach/jejunum-esophagus anastomosis with circular stapler, it is important that the mucosa of the excised esophagus be non-interupted, that the thickness of the rim of the anastomotic tissue be held within a reasonable range, and that the area of the excised stomach be large enuough. Anastomosis with circular stapler is less demanding of the surgeon, and less time consuming. Therefore the use of the stapler contributes to reduction of postoperative complications.