下咽癌术中经口使用环形吻合器重建消化道的临床探讨

Transoral use of circular stapler in reconstruction of digestive tract in hypopharyngeal carcinoma surgery

目的探讨下咽癌术中经口使用环形吻合器连接重建消化道上吻合口的方法及疗效。方法回顾性分析2016年3月~2018年12月因下咽癌就诊于北京协和医院耳鼻咽喉科行手术治疗并于术中经口应用环形吻合器修复口咽缺损的7例患者的临床资料。结果7例患者均未出现咽瘘和上吻合口狭窄。1例于术后19个月因肺部转移死亡,1例于术后9个月出现下吻合口狭窄。结论下咽癌术中可以经口置入环形吻合器以重建消化道上端,效果较好,术后吻合口瘘、上吻合口狭窄的发生率低于手工缝合,同时更加省时,可靠。关于经口使用环形吻合器的适应证与禁忌证仍需更多的临床探索。

Objective To investigate the method and effect of transoral use of circular stapler to connect upper anastomotic stoma in reconstruction of digestive tract.Methods Clinical data of 7 patients suffering from hypopharyngeal carcinoma undergoing surgical removal and receiving reconstruction of postoperative oropharyngeal defects with circular stapler transorally in our department from March 2016 to Dec 2018 were analyzed retrospectively.Results Neither pharyngeal fistula nor upper anastomotic stenosis was found in all cases.One patient died of lung metastasis 19 months after surgery and one had lower anastomotic stenosis 9 months after surgery.Conclusions In the reconstruction of the digestive tract after surgical removal of hypopharyngeal carcinoma,circular stapler can be inserted transorally to anastomose the upper end of the digestive tract with good effect.The incidences of anastomotic fistula and upper anastomotic stenosis are lower than those of manual suture,with advantages of time-saving and reliability.More clinical explorations are needed to determine the indications and contraindications of transoral use of circular stapler.