【摘要】 目的 :探讨食管胃吻合抗反流术式。方法 :以犬为实验对象。在胃底前壁剥除约 8× 4cm浆肌层成形为粘膜管 ,食管粘膜延长 1 5cm与胃部成形粘膜管分层吻合。分别于手术后 7～ 180天处死检测 ,同“深套叠”术式对比分析。结果 :残留粘膜血供良好。肌层吻合口直径及突入胃腔内结构长度两组无差别 (P >0 .0 5 ) ,粘膜吻合口直径差异显著 (P <0 .0 1)。实验组能耐受较高胃内压 ,胃与食管压力差两组比较有显著性差异 (P <0 .0 1)。突向胃腔内结构厚度两组比较相差 1倍以上。结论 :①适当剥除肌层不引起粘膜缺血坏死。②成形粘膜瓣较薄 ,在食管与胃压力差作用下关闭性强 ,具有良好抗反流效果。③不同平面分层吻合具有一定预防吻合口瘘及狭窄作用更多还原

【Abstract】 Objective: To explore the anti reflux operation style about the esophagogastrostomy. Methods: We chose the dogs as the experimental objects.At first we resected the seromuscular layer by 8×4 cm on the front wall of the gastric fundus to shape up a mucous membrane tube.Then the mucous membrane of esophagus was lengthened by 1.5 cm and anastomosed with the mucous membrane tube of gaster layer by layer separately.The dogs were killed 7～180 days after operation and contrasted with those on which were operated of “deep intussusception”. Results: The blood supply of the underlying mucous membrane was good.The diameter of the anastomotic stoma of the muscular layer and the length of the protrusion into the gastric cavity were not significantly different in two groups ( P>0.05 ).The diameter of the anastomotic stoma of the mucous membrane was obviously different in two groups ( P<0.01) .The experimental group could bear more gastric pressure.The pressure change of gaster with esophagus was significantly different in two groups ( P<0.01). The thickness of the protrusion into the gastric cavity was differ by more than one time in two groups. Conclusion: ① To resect the muscular layer properly does not result in ischemic necrosis of the mucous membrane.② Because the valve of the mucous membrane shaped up is thin,its close function is strong when the pressure change of gaster with esophagus act on it.So it has better antireflux result.③ To anastomose in different planes layer by layer separately can prevent from the fistula and stricture of the anastomotic stoma in a certain degree.更多还原