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目的 :对食管胃侧侧吻合方式进行改进,使其成为完全的“侧方”、“线形”吻合,提高抗反流效果及安全性。方法 :选取2009年8月~2013年8月在江苏省肿瘤医院胸外科食管、贲门癌入院患者,实施胃食管端侧吻合术103例(端侧吻合组)、侧侧吻合术95例(侧侧吻合组)、全侧侧吻合术82例(全侧侧吻合组)。全侧侧吻合组采用“器械+手工”将食管完全侧方线形吻合于胃管,然后将食管横行闭合,使得食管胃成为一个完整的侧侧吻合。术后统计并发症,测定反流,并随访有无狭窄。结果:端侧吻合术组、侧侧吻合组、全侧侧吻合组术后吻合口瘘分别发生2例、1例、0例,吻合口狭窄分别发生18例、1例、0例,近期反流分别发生42例、16例、10例,其他并发症分别为5例、6例、4例。端侧吻合组死亡1例,其他两组无死亡病例。端侧吻合组在术后吻合口狭窄、反流发生方面与其他两组差异有统计学意义,而在其他并发症方面差异无统计意义。侧侧吻合组、全侧侧吻合组远期反流测定分别随访88例、76例,发生远期反流分别有31例、18例,轻度反流分别为19例、15例,中度反流分别为11例、3例,重度反流分别为1例、0例。与侧侧吻合组比较,全侧侧吻合组中重度反流明显减少。结论:食管胃全侧侧吻合可以更好地达到侧侧吻合设计初始所要求的侧方线形吻合,并呈现出更好地预防狭窄、抗反流趋势及安全性。
OBJECTIVE: To improve the esophagogastric anastomosis and make it a complete “lateral”, “linear” anastomosis to improve the anti-reflux effect and safety. Methods: From August 2009 to August 2013, 103 patients with endoscopic anastomosis (end-to-end anastomosis group) and 95 patients with lateral anastomosis (end-to-side anastomosis) were enrolled in the thoracic esophagus and cardia cancer hospital of Jiangsu Provincial Tumor Hospital. Side anastomosis group), all side anastomosis in 82 cases (all side anastomosis group). All side of the anastomosis group using “instruments + manual ” the esophagus completely lateral line-shaped anastomosis in the stomach, and then esophageal closure, making the esophagus become a complete side of the anastomosis. Statistics postoperative complications, determination of reflux, and follow-up with or without stenosis. Results: There were 2 cases, 1 case, 0 case in the anastomosis group, lateral side anastomosis group and all lateral side anastomosis group, 18 cases in anastomosis stenosis, 1 case and 0 case, respectively Flow occurred in 42 cases, 16 cases, 10 cases, other complications were 5 cases, 6 cases, 4 cases. One patient died in the anastomosis group and the other two patients did not die. End-side anastomosis group in the postoperative anastomotic stenosis, reflux occurred with the other two groups was statistically significant, but no significant difference in other complications. Lateral anastomosis group, all-side anastomosis group long-term reflux were followed up 88 cases, 76 cases, the occurrence of long-term reflux were 31 cases, 18 cases, mild reflux were 19 cases, 15 cases, moderate Reflux were 11 cases, 3 cases, severe reflux were 1 cases, 0 cases. Compared with the lateral anastomosis group, severe reflux in the all-lateral anastomosis group was significantly reduced. CONCLUSIONS: Esophagogastric full side anastomosis can better achieve the lateral linear anastomosis required by the initial design of lateral anastomosis, and show better prevention of stenosis, anti-reflux tendency and safety.