胃引流术治疗食管、贲门癌切除术后食管胃反流的临床体会

目的:探讨食管、贲门癌切除术后胃食管反流治疗方法。方法:将174例食管贲门癌患者分为两组,观察组86例在行单纯食管胃颈部或胸腔内吻合重建消化道基础上加做胃引流术;对照组(88例)行单纯食管颈部或胸腔吻合重建消化道。应用24 h食管pH监测及临床反流症状评定方法进行比较。结果:24 h pH监测显示,观察组Demeester评分为2.03±2.23,对照组为103.41±91.36,两组比较差别有统计学意义(P<0.05)。临床反流症状评定显示,观察组18例有反流症状,对照组52例出现反流症状,两组比较差异有统计学意义(P<0.05)。结论:胃引流术能有效降低患者胃食管反流的发生率,具有创伤小、效果好、易操作等特点,值得临床广泛应用。

Totally laparoscopic trans-hiatal gastroesophagectomy for benign diseases of the esophago-gastric junction

AIM： To prospectively present our initial experience with totally laparoscopic transhiatal esophagogastrectomies for benign diseases of the cardia and distal esophagus. METHODS： Laparoscopic gastric mobilization and tubularization combined with transhiatal esophageal dissection and intrathoradc esophagogastric anastomosis accomplished by a circular stapler was done in 3 patients. There were 2 females and 1 male patient with a mean age of 73 ± 5 years. RESULTS： Two patients were operated on due to benign stromal tumor of the cardia and one patient had severe oesophageal peptic stenosis. Mean blood loss was 47 ± 15 mL and mean operating time was 130 ± 10 rain. There were no cases that required conversion to laparotomy. All patients were extubated immediately after surgery. Soft diet intake and ambulation times were 5.1 ± 0.4 d and 2.6 ±0.6 d, respectively. There were no intraoperative and postoperative complications and there were no perioperative deaths. The average length of hospital stay was 9.3 ± 3 d. All procedures were curative and all resected margins were tumor free. The mean number of retrieved lymph nodes was 18 ±8. CONCLUSION： Laparoscopic transhiatal esophagogastrectomy for benign lesions has good effects and proves feasible and safe.

Successful treatment of corrosive esophageal strictures after failed esophageal reconstructions with colon and jejunum

Dense and extensive esophageal strictures after caustic agent ingestion require surgical treatment. Colon, stomach and jejunum can be used to reconstruct esophagus. Here, we report an unusual patient with corrosive esophageal stricture who had received unsuccessful esophageal replacements twice at other hospitals. Colon interposition had been first performed 6 months after corrosive esophageal burn, but the colon graft necrosis occurred. Esophageal reconstruction had been carried out 10 years later in another hospital. However, the graft necrosis developed again 5 months later. A salvage operation was performed to remove the necrotic transplant in our hospital. Then as much food as possible had been given to expand the stomach through the gastrostomy since the procedure. The patient underwent esophagecto-my and concomitant gastroesophagostomy in the neck 1. 5 years later. Esophageal dilations had been performed to prevent recurrent anastomotic stricture for 1 year. He has eaten a normal diet since being discharged.

Spleen and pancreatic tail thorax translocation facilitating residual stomach esophagus anastomosis

Objective:To investigate the value of spleen and pancreatic tail thorax translocation on the residual stomach esophagus anastomosis.Methods:10 patients with esophageal carcinoma after gastrectomy were enrolled in this study. Lesions were removed through left thoracotomy and residual stomach was fully mobilized,with short gastric artery being re- served.Spleen and pancreatic tail were dissected from the back of peritoneum and transposed into thorax.Residual stomach esophagus anastomosis was performed.Results:All the operation went favorably.Patients were recovered rapidly and a relatively good prognosis was acquired.Late leakage and pleural effusion happened in one case respectively,but these com- plications were cured through conservative management without operation death.Conclusion:Residual stomach is an ideal candidate for the replacement of esophagus and residual stomach esophagus anastomosis is a simple operative alternative with few trauma and good results for the treatment of esophageal carcinoma after gastrectomy.

The effect of disc-shaped gastric resection of anastomosis site on reducing postoperative dysphagia and stricture after esophagogastric anastomosis in patients with esophageal cancer

Background:Esophagectomy remains the most reliable technique for managing esophageal cancer,but anastomotic complications including postoperative leak,ischemia and stricture negatively affect outcomes of this specific surgery.The aim of this study was to evaluate the effects of a novel method of esophagogastric anastomosis for reducing postoperative dysphagia and stricture formation.Methods:Eighty patients who were scheduled for esophagectomy due to esophageal cancer were randomly assigned into two groups:intervention and control(40 each).In the control group,the esophagogastric anastomosis was performed with a linear gastric incision,whilst in the intervention group a new method of disc-shaped gastric resection for anastomosis was applied.Postoperative outcomes were compared between the two groups.Results:The incidence of postoperative dysphagia and anastomotic stricture was significantly lower in the disc-shaped resection group(dysphagia 45%vs 75%,P=0.02;stricture 12.5%vs 32.5%,P=0.03),whilst the length of stay in an intensive care unit(ICU),anastomotic leakage and other complications were not significantly different between the two groups(all P>0.05).Conclusion:Anastomotic complications can be reduced by improving surgical techniques.The decreased incidence of postoperative dysphagia and anastomotic stricture in our study may be partly due to providing the proper diameter for the site of anastomosis when using the disc-shaped gastric resection method.Hence,this new method can improve the clinical outcomes of patients who undergo esophagectomy with esophagogastric anastomosis.