【摘要】 目的探讨在食管不同手术入路中应用直线型缝合器行食管胃吻合以减少术后吻合口狭窄的效果。方法自2008年1月~2009年10月应用直线型缝合器纵向缝合食管胃吻合口后壁,使吻合口后壁延长至3 cm以上,应用可吸收缝线连续缝合吻合口前壁,完成食管胃侧侧吻合12例。术后随访观察进食情况,纤维胃镜、造影评估吻合口内径。结果12例均顺利完成食管胃吻合术,胸内吻合10例(83.3%),颈部吻合2例(16.7%)。经左胸切口行食管胃弓下吻合6例,经左胸切口行食管胃弓上吻合2例,经腹部正中切口、右胸切口行食管胃胸顶吻合2例,经三切口行食管胃颈部吻合2例。术后无吻合口瘘,切缘无癌残留,但发生腹部切口感染1例。术后随访1~18个月,进食通畅,行胃镜检查4例,造影检查8例,吻合口直径平均1.5(1.4~1.7)cm,无吻合口狭窄。结论应用直线型缝合器行食管胃吻合通过增加吻合口内径、改变吻合口位置减少了术后吻合口狭窄的发生,是替代传统管型吻合器吻合的有效手术方法。更多还原

【Abstract】 Objective To recommend a new method to complete the esophagogastric anastomosis to decrease the rate of anastomotic stricture by using linear endostapler instead of circular stapler.Methods Linear endoscopic stapler was used to create a more than 3cm posterior wall of esophagogastic anastomosis,then the hand-sewn techniques was used with the 3-0 absorbable monofilament suture to close the anterior wall of the anastomosis.Between January 2008 and October 2009,this hand-sewn combined with mechanical stapled anastomosis was performed in 12 patients,including 6 of below aortic arch espohagogastrostomy through left thoracic approach,2of supra aortic arch espohagogastrostomy through left thoracic approach,2 of espohagogastrostomy at the chest apical through right thoracic approach,and 2 of cervical espohagogastrostomy through tri-incision approach.Patients were routinely followed up postoperatively at the 1 month,3 months and then as needed,and the barium swallow study or electronic gastroscopy was obtained to evaluate the diameter of anastomosis.Results No anastomotic leakage occurred in this series,no positive marginal tumor residual happened.Abdominal incision infection occurred in one patient.All the patients were followed up for 1 to 18 months,no dysphagia was found.According to the resulst of barium swallow study of 8 patients and the endogastroscopy of 4 patients postoperatiently,no anastomotic stricture was found,the diameter of anastomosis ranged from 1.4cm to 1.7cm,mean 1.5cm.Conclusion Using linear endostapler instead of circular stapler to perform the esophagogastric anastomosis is an effective method,which could decrease the stricture rate because of its larger diameter.更多还原